Key result
Impella support increases mean arterial pressure and coronary flow during protected PCI and cardiogenic shock.
Why the study?
IABP provides limited support and failed to demonstrate benefit in high-risk PCI or cardiogenic shock, prompting a review of current data on Impella mechanical circulatory support devices.
This review highlights the physiological benefits and current data supporting the use of Impella mechanical circulatory support devices in protected PCI and cardiogenic shock.
Hemodynamic effects may justify Impella in protected PCI or shock; leaves open impact on clinical outcomes pending RCTs.
Intra-aortic balloon pump (IABP) has been used for many years in high-risk PCI or cardiogenic shock. However, the support provided by IABP is limited and a major randomised controlled trial failed to demonstrate a beneficial effect.¹ Impella® is a family of percutaneous mechanical circulatory support (MCS) devices that are used in protected PCI and cardiogenic shock.² Depending on the device model, they provide a blood flow ranging from 2.5 to 5 L/min. The resulting augmented support increases mean arterial blood pressure, cardiac output and coronary flow while unloading left ventricular filling pressure to reduce myocardial oxygen demand.² ³ This is an ideal form of temporary support device for the patient. Moreover, the device is easy to set up and can be inserted very quickly to stabilise the patient. This presentation provides a review on the current data regarding the use of Impella MCS devices. References Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K; IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012;367:1287–1296. O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavík V, Popma J, Douglas PS, Ohman M. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012;126:1717–1727. O’Neill WW, Grines C, Schreiber T, Moses J, Maini B, Dixon SR, Ohman EM. Analysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device. Am Heart J 2018;202:33–38.
No takes yet. Share an insight, caveat, or question.
Chui Ka Lung (2019) conducted a review in Protected PCI and cardiogenic shock. Impella was evaluated. Impella mechanical circulatory support devices provide blood flow ranging from 2.5 to 5 L/min, increasing mean arterial pressure and coronary flow during protected PCI and cardiogenic shock.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: