Prediction of survival of patients in cardiogenic shock treated by surgically implanted Impella 5+ short-term left ventricular assist device

Abstract

OBJECTIVES Short-term mechanical circulatory support is a life-saving treatment for acute cardiogenic shock (CS). This multicentre study investigates the preoperative predictors of 30-day mortality in CS patients treated with Impella 5.0 and 5.5 short-term left ventricular assist devices. METHODS Data of patients in CS (n = 70) treated with the Impella 5 (n = 63) and 5.5 (n = 7) in 2 centres in Berlin between October 2016 and October 2019 were collected retrospectively. RESULTS CS was caused by acute myocardial infarction (n = 16), decompensated chronic heart failure (n = 41), postcardiotomy syndrome (n = 5) and acute myocarditis (n = 8). Before implantation 12 (17%) patients underwent cardiopulmonary resuscitation and 32 (46%) patients were ventilated. INTERMACS level 1, 2 and 3 was established in 35 (50%), 29 (41%) and 6 (9%) of patients, respectively. The mean preoperative lactate level was 4.05 mmol/l. The median support time was 7 days (IR= 4–15). In 18 cases, the pump was removed for myocardial recovery, in 22 cases, durable left ventricular assist devices were implanted, and 30 patients died on support. The overall 30-day survival was 51%. Statistical analysis showed that an increase in lactate per mmol/l [odds ratio (OR) 1.217; P = 0.015] and cardiopulmonary resuscitation before implantation (OR 16.74; P = 0.009) are predictors of 30-day survival. Based on these data, an algorithm for optimal short-term mechanical circulatory support selection is proposed. CONCLUSIONS Impella treatment is feasible in severe CS. Severe organ dysfunction, as well as the level and duration of shock predict early mortality. An algorithm based on these parameters may help identify patients who would benefit from Impella 5+ support.

A case series analysis on the clinical experience of Impella 5.5® at a large tertiary care centre

“…report outcomes of patients supported with Impella 5 (63 patients) and 5.5 (seven patients) and concluded that in this cohort, an increased lactate level and cardiopulmonary resuscitation (CPR) before pVAD deployment were predictors of 30 days of survival. 13 In our cohort, only two patients were resuscitated before device placement, both patients presented with ST‐elevation myocardial infarction, and both died after 7 and 30 days on Impella support, respectively. Of note, none of the patients in our cohort had elevated lactate levels at device implant, likely due to other mechanical circulatory support having been in place before pVAD 5.5 (mostly Impella CP or ECMO).…”

Successful use of Impella 5.5 to manage cardiogenic shock complicated by COVID‐19

“…In the context of CS refractory to inotropic therapy, unloading the LV with MCS can improve native heart function. [5][6][7] Here, we report on a 65-year-old male with profound CS whose heart function improved with Impella 5.5 support. COVID-19 infection was initially managed with Remdesivir but discontinued due to acute kidney injury.…”

“…In the context of CS refractory to inotropic therapy, unloading the LV with MCS can improve native heart function 5–7 . Here, we report on a 65‐year‐old male with profound CS whose heart function improved with Impella 5.5 support.…”

Propensity score‐based analysis of 30‐day survival in cardiogenic shock patients supported with different microaxial left ventricular assist devices

“…In the absence of ventricular contractility, this can lead to pulmonary hypertension and subsequently to interstitial lung edema 8 . Therefore, in case of isolated left ventricular failure, microaxial left ventricular assist devices such as the Impella (Abiomed Inc.) can be used as an alternative to or in combination with ECLS 9 …”