Overview of Impella and mechanical devices in cardiogenic shock

Chera, Hymie; Nagar, Menachem; Chang, Nai lun; Morales-Mangual, Carlos; Dous, George; Marmur, Jonathan D.; Ihsan, Muhammad; Madaj, Paul; Rosen, Yitzhak

doi:10.1080/17434440.2018.1456334

Cited by 35 publications

(20 citation statements)

References 36 publications

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“…The Impella CP and IABP are commonly used mechanical support devices with each having a unique operational paradigm. The Impella is an axial flow percutaneous ventricular assist device positioned across the aortic valve that propels blood antegrade into the aorta to directly offload the LV throughout the cardiac cycle 28‐30 . In contrast, IABP counterpulsation unloads the LV indirectly through decreasing afterload during systole to promote LV ejection 18,31,32 .…”

Section: Discussionmentioning

confidence: 99%

Left ventricle unloading strategies in ECMO: A single‐center experience

et al. 2020

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Introduction Extracorporeal membrane oxygenation (ECMO) is a life‐saving technology capable of restoring perfusion but is not without significant complications that limit its realizable therapeutic benefit. ECMO‐induced hemodynamics increase cardiac afterload risking left ventricular distention and impaired cardiac recovery. To mitigate potentially harmful effects, multiple strategies to unload the left ventricle (LV) are used in clinical practice but data supporting the optimal approach is presently lacking. Materials & Methods We reviewed outcomes of our ECMO population from September 2015 through January 2019 to determine if our LV unloading strategies were associated with patient outcomes. We compared reactive (Group 1, n = 30) versus immediate (Group 2, n = 33) LV unloading and then compared patients unloaded with an Impella CP (n = 19) versus an intra‐aortic balloon pump (IABP, n = 16), analyzing survival and ECMO‐related complications. Results Survival was similar between Groups 1 and 2 (33 vs 42%, P = .426) with Group 2 experiencing more clinically‐significant hemorrhage (40 vs. 67%, P = .034). Survival and ECMO‐related complications were similar between patients unloaded with an Impella versus an IABP. However, the Impella group exhibited a higher rate of survival (37%) than predicted by their median SAVE score (18%). Discussion Based on this analysis, reactive unloading appears to be a viable strategy while venting with the Impella CP provides better than anticipated survival. Our findings correlate with recent large cohort studies and motivate further work to design clinical guidelines and future trial design.

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Section: Discussionmentioning

confidence: 99%

Left ventricle unloading strategies in ECMO: A single‐center experience

et al. 2020

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“…The Impella CP is a 9‐Fr catheter‐mounted microaxial rotary blood pump (14 Fr) designed for temporary MCS of less than or equal to 6 h in patients undergoing high‐risk PCI and less than or equal to 4 days for patients with cardiogenic shock 3 . The device can provide up to 4.3 L/min of flow and is inserted percutaneously via the femoral artery 14 . The Impella 5.0 and LD are both 9–Fr catheter‐mounted microaxial rotary blood pumps (21 Fr) designed for temporary MCS of less than or equal to 14 days in patients with cardiogenic shock 3 .…”

Section: Methodsmentioning

confidence: 99%

“…The Impella 5.0 and LD are both 9–Fr catheter‐mounted microaxial rotary blood pumps (21 Fr) designed for temporary MCS of less than or equal to 14 days in patients with cardiogenic shock 3 . Both the Impella 5.0 and LD can provide up to 5.0 L/min of flow and were inserted directly through a 10‐mm vascular graft 14 . The Impella 5.0 is inserted via a cutdown of either the femoral or axillary artery and the Impella LD is inserted into the ascending aorta via an open chest procedure 3 .…”

Section: Methodsmentioning

confidence: 99%

“…3 Both the Impella 5.0 and LD can provide up to 5.0 L/min of flow and were inserted directly through a 10-mm vascular graft. 14 after Impella implant, and the presence of at least one of the following conditions hyperbilirubinemia (i.e., total bilirubin ≥ 2 mg/dl), pump malfunction or pump suction alarms, and/or haptoglobin less than or equal to 45 mg/dl. 15 Secondary outcomes were incidence of ischemic or hemorrhagic stroke, incidence of additional MCS with upgrade to either Impella 5.0/LD or ECMO, survival to Impella explant, and overall hospital admission outcome.…”

Section: Device Characteristicsmentioning

confidence: 99%

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Comparison of device‐specific adverse event profiles between Impella platforms

Chen

Paone

Spellman³

et al. 2020

J Card Surg

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Background: The Impella (Abiomed) ventricular support system is a family of temporary mechanical circulatory support (MCS) devices used to treat patients with cardiogenic shock, acute cardiogenic decompensation, and for high-risk percutaneous or surgical revascularization. These devices include the percutaneously implanted 2.5/cardiac power (CP) and the surgically implanted 5.0/left direct (LD). Despite the beneficial effects and increased usage of these devices, data to assess adverse outcomes and guide clinician decision-making between the Impella CP and 5.0/LD are limited. Methods: This is a retrospective analysis of 91 consecutive patients who required at least 24 h of Impella support, from January 1, 2015 to December 31, 2019. Groups were stratified based on either initial Impella CP or 5.0/LD placement. Clinical outcomes and in-hospital complications were compared. Results: Impella CP was implanted in 66 patients (mean age: 61 ± 15 years, male 71.2%) and Impella 5.0/LD was implanted in 25 patients (mean age: 62 ± 9 years, male 84.0%). There was greater stability of device position (p = .033), less incidence of hemolysis (p < .001), and less frequent need for additional MCS (p = .001) in patients implanted with the Impella 5.0/LD compared with Impella CP in this study cohort. Patients with Impella 5.0/LD were more likely to survive from Impella and survive to discharge. Conclusions: This study suggests that for patients who require temporary MCS for more than 24 h, the Impella 5.0/LD may have a more favorable device-specific adverse profile compared with the Impella CP.

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“…All Impella pumps, except the Impella 5.0 can be inserted percutaneously into the femoral artery and create a non-pulsatile, forward flow into the aorta. Previous studies have shown that Impella improves MAP [1], reduces LV-Load, end-diastolic pressure, oxygen consumption and myocardial work [2]. The ISAR-SHOCK Trial showed that Impella provided numerous hemodynamic improvements including cardiac index, cardiac output, MAP 30 minutes after implantation with reversal of serum lactate values [3].…”

Section: Introductionmentioning

confidence: 98%

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

et al. 2021

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Background Critically ill patients with cardiogenic shock could benefit from ventricular assist device support using the Impella microaxial blood pump. However, recent studies suggested Impella not to improve outcomes. We, therefore, evaluated outcomes and predictors in a real-world scenario. Methods In this retrospective single-center trial, 125 patients suffering from cardiac arrest/cardiogenic shock between 2008 and 2018 were analyzed. 93 Patients had a prior successful cardiopulmonary resuscitation. The primary endpoint was hospital mortality. Associations of covariates with the primary endpoint were assessed by univariable and multivariable logistic regression. Adjusted odds ratios (aOR) and optimal cut-offs (using Youden index) were obtained. Results Hospital mortality was high (81%). Baseline lactate was 4.7mmol/L [IQR = 7.1mmol/L]. In multivariable logistic regression, only age (aOR 1.13 95%CI 1.06–1.20; p<0.001) and lactate (aOR 1.23 95%CI 1.004–1.516; p = 0.046) were associated with hospital mortality, and the respective optimal cut-offs were >3.3mmol/L and age >66 years. Patients were retrospectively stratified into three risk groups: Patients aged ≤66 years and lactate ≤3.3mmol (low-risk; n = 22); patients aged >66 years or lactate >3.3mmol/L (medium-risk; n = 52); and patients both aged >66 years and lactate >3.3mmol/L (high-risk, n = 51). Risk of death increased from 41% in the low-risk group, to 79% in the medium risk group and 100% in the high-risk group. The predictive abilities of this model were high (AUC 0.84; 95% 0.77–0.92). Conclusion Mortality was high in this real-world collective of severely ill cardiogenic shock patients. Better patient selection is warranted to avoid unethical use of Impella. Age and lactate might help to improve patient selection.

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Overview of Impella and mechanical devices in cardiogenic shock

Cited by 35 publications

References 36 publications

Left ventricle unloading strategies in ECMO: A single‐center experience

Left ventricle unloading strategies in ECMO: A single‐center experience

Comparison of device‐specific adverse event profiles between Impella platforms

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

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