What is the clinical evidence from this study?

Study design: Observational. Population: Refractory cardiogenic shock (n=40). Intervention: Impella 5.0. Primary outcome: Day-28 mortality.

What does this research mean for the field?

In patients with refractory cardiogenic shock, support with the Impella 5.0 device significantly reduces inotrope requirements, improves left ventricular ejection fraction, and yields a 65% 28-day survival rate, which is better than predicted by admission severity scores. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 9, 2015Critical CareOpen Access

Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock

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Key result

Impella 5.0 in refractory cardiogenic shock links to ~70% recovery or bridge to LVAD or transplant.

n=40

Population

40 patients with refractory cardiogenic shock, median age 57 years, 87.5% male. Etiologies included acute…

Design

Cohort

Follow-up

28 days

Authors

PGPhilippe GaudardCentre National de la Recherche Scientifique MMMarc MouradClearMotion (United States)JEJacob ElietHôpital Arnaud de Villeneuve

Discussion

Member takes

Implication

Hypothesis-generating for Impella 5.0 in refractory cardiogenic shock; randomized trials needed before practice change.

Study Design

Type

Observational (n=40)

Multicenter

Structured PICO

Population

40 patients with refractory cardiogenic shock, median age 57 years, 87.5% male. Etiologies included acute myocardial infarction (43%), dilated cardiomyopathy (30%), and postcardiotomy cardiac failure (18%). Median SOFA score prior to support was 12.

Intervention

Impella 5.0 percutaneous left ventricular assist device for a median duration of 7 days (added to ECMO in 15 patients to unload the left ventricle).

Outcome

Hemodynamics and outcome to the first 48 h of support, to ICU discharge and day-28 visithard clinical

Impella 5.0 support in refractory cardiogenic shock is associated with rapid hemodynamic improvement and a 65% survival rate at 28 days.

Limitations

Retrospective, single-center design
Small sample size
Lack of a control group
Selection bias regarding which patients on PVA-ECMO received Impella
Missing detailed echocardiographic data (only LVEF systematically reported)
Heterogeneous etiologies of cardiogenic shock mixed in the cohort

Cite This Study

Gaudard et al. (2015) conducted an observational in Refractory cardiogenic shock (n=40). Impella 5.0 was evaluated on Day-28 mortality. Impella 5.0 support in patients with refractory cardiogenic shock resulted in a day-28 mortality rate of 35% and enabled cardiac recovery or bridge to LVAD or transplantation in 70% of patients.

synapsesocial.com/papers/6a0f84944fb650da4ffe37cd https://doi.org/10.1186/s13054-015-1073-8

Topics

Mechanical circulatory support Echocardiography

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Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Topics

Management and outcome of patients supported with Impella 5.0 for refractory cardiogenic shock

Discussion

Member takes

Implication

Study Design

Structured PICO

Limitations

Cite This Study

Also Consider

Topics

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