Impella use in real-world cardiogenic shock patients: Sobering outcomes

Abdullah, Khaled Q. A.; Roedler, Jana V.; Dahl, Juergen vom; Szendey, Istvan; Haake, Hendrik; Eckardt, Lars; Topf, Albert; Ohnewein, Bernhard; Jirak, Peter; Motloch, Lukas J.; Wernly, Bernhard; Larbig, Robert

doi:10.1371/journal.pone.0247667

Cited by 3 publications

(3 citation statements)

References 15 publications

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“…The hospital mortality was 81% and associated with age (> 66 years) and lactate levels (3.3 mmol/L). This study suggests the importance of patient selection with consideration of age and lactate levels (40). A meta-analysis of Impella in 671 CS patients following myocardial infarction also showed a high 30-day mortality of 54.6%.…”

Section: Left-ventricular Assist Devicesmentioning

confidence: 65%

Updates on Cardiogenic Shock: Diagnosis and Management

Laksono,

Pandu Pratama,

Swastika Putri

et al. 2023

JUMMEC

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Cardiogenic shock (CS) is a complex condition causing end-organ hypoperfusion and high mortality rates especially in patients with acute myocardial infarction. It remains a challenge for clinician to provide good outcomes despite the development of evidence-based therapeutic strategies, especially for interventional management. Although there has been an improvement in survival, the mortality remains high. There are still many uncertainties regarding the best treatment, as clinicians need to weigh the risks and benefits. This review aims to elaborate the latest updates in the field of CS. To enhance contractility and systemic vascular resistance and hence avoid organ damage, inotropic and vasopressin agents are often administered in the therapy of CS. Despite their usefulness and widespread use, administration of these medicines requires close monitoring and the lowest effective dosage administered in the shortest amount of time possible to prevent adverse effects including increased oxygen demand, arrhythmia, and impaired microcirculation of the tissue. When pharmacological agents fail to provide an adequate response, mechanical circulatory support (MCS) devices like the intraaortic balloon pump (IABP), left ventricular assist devices (LVAD), venoarterial extracorporeal membrane oxygenation (VA-ECMO), and revascularization become an option to provide haemodynamic support.

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Section: Left-ventricular Assist Devicesmentioning

confidence: 65%

Updates on Cardiogenic Shock: Diagnosis and Management

Laksono,

Pandu Pratama,

Swastika Putri

et al. 2023

JUMMEC

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show abstract

“…The improvement in cardiac function was perceived after using the Impella device in these patients. However, before this device was implanted, risk factors, such as age and lactate levels, had to be considered before deciding the management [9].…”

Section: Discussionmentioning

confidence: 99%

“…It continuously extracts blood from the left cavity and unloads it into the arterial circulation, improving circulation, preventing systemic hypotension and tissue hypofunction, and decreasing the severity of the complications. However, some factors, such as age and lactate levels, could be decisive in their use [8,9].…”

Section: Introductionmentioning

confidence: 99%

The Therapeutic Use of Impella Device in Cardiogenic Shock: A Systematic Review

Tello¹,

Jamil²,

Tran³

et al. 2022

Cureus

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Impella (Abiomed, Danvers, MA) devices nowadays have been linked to cardiogenic shock (CS) due to the importance of their use as therapeutic instruments. This study aims to review pathophysiologic mechanisms of cardiogenic shock and the implementation of Impella to overcome this condition. To investigate several different types of studies and analyze the use of Impella device in cardiogenic shock and the outcomes of heart malfunctioning and determine its positive and negative impacts as a therapeutic tool in cardiac ischemia and use as a resource in critical patients, we conducted a systematic review through different databases (PubMed, ScienceDirect, and Google Scholar) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and used the Medical Subjects Heading (MeSH) search strategy to obtain significant articles. We found 883 papers in total, and after removing duplicates, applying inclusion/exclusion criteria, and finding the most significant information, we ended up with 30 articles that were reviewed containing information about the impact of Impella device in cardiogenic shock in different locations. The study strongly concludes that Impella device in the setting of cardiogenic shock has more advantages than disadvantages in terms of outcomes and complications as a non-pharmacologic tool. Improvements in left ventricular ejection fraction and signs and symptoms of cardiogenic shock criteria were determinants. Nevertheless, complications during the implementation and use of the device were established; in this manner, the evaluation and treatment of each patient separately are imperative. Consequently, more studies on this relevant topic are needed.

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Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Tan

Low²,

Ng³

et al. 2022

Life

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Microaxial left ventricular assist devices (LVAD) are increasingly used to support patients with cardiogenic shock; however, outcome results are limited to single-center studies, registry data and select reviews. We conducted a systematic review and meta-analysis, searching three databases for relevant studies reporting on microaxial LVAD use in adults with cardiogenic shock. We conducted a random-effects meta-analysis (DerSimonian and Laird) based on short-term mortality (primary outcome), long-term mortality and device complications (secondary outcomes). We assessed the risk of bias and certainty of evidence using the Joanna Briggs Institute and the GRADE approaches, respectively. A total of 63 observational studies (3896 patients), 6 propensity-score matched (PSM) studies and 2 randomized controlled trials (RCTs) were included (384 patients). The pooled short-term mortality from observational studies was 46.5% (95%-CI: 42.7–50.3%); this was 48.9% (95%-CI: 43.8–54.1%) amongst PSM studies and RCTs. The pooled mortality at 90 days, 6 months and 1 year was 41.8%, 51.1% and 54.3%, respectively. Hemolysis and access-site bleeding were the most common complications, each with a pooled incidence of around 20%. The reported mortality rate of microaxial LVADs was not significantly lower than extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumps (IABP). Current evidence does not suggest any mortality benefit when compared to ECMO or IABP.

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Impella use in real-world cardiogenic shock patients: Sobering outcomes

Cited by 3 publications

References 15 publications

Updates on Cardiogenic Shock: Diagnosis and Management

Updates on Cardiogenic Shock: Diagnosis and Management

The Therapeutic Use of Impella Device in Cardiogenic Shock: A Systematic Review

Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

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