Key result
This review provides a comprehensive overview of short-term mechanical circulatory support (Impella) and describes a practical approach to optimize care for patients with cardiogenic shock.
Why the study?
Limited and conflicting evidence exists regarding the role of the Impella device in cardiogenic shock, necessitating further randomized trials and practical management guidance.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“A lot of focus is on the early implantation, on the cath lab, but there's not a lot of focus on the further management in the ICU. Our experience was that the final outcome was, say, 20% what happens in the cath lab and 80% what happens in the cardiac intensive care unit.”
“To date there have not been any randomized clinical trials looking at best practices for device management beyond the cath lab. In the absence of [these] to inform management, best practices are best practices for each institution—it's local.”
This review outlines practical management strategies for patients with cardiogenic shock receiving short-term mechanical circulatory support with Impella.
The use of mechanical circulatory support for patients presenting with cardiogenic shock is rapidly increasing. Currently, there is only limited and conflicting evidence available regarding the role of the Impella (a microaxial, continuous-flow, short-term, left or right ventricular assist device) in cardiogenic shock; further randomized trials are needed. Patient selection, timing of implantation, and post-implantation management in the cardiac intensive care unit are crucial elements for success. Particular challenges at the bedside include the practical management of anticoagulation, evaluation of correct device position, and the approach to use in a patient with signs of insufficient hemodynamic support. Profound knowledge of these issues is required to enable the maximal potential of the device. This review provides a comprehensive overview of the short-term assist device and describes a practical approach to optimize care for patients supported with the device.
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Balthazar et al. (2021) conducted a review in Cardiogenic shock. Short-term mechanical circulatory support (Impella) was evaluated. This review provides a comprehensive overview of short-term mechanical circulatory support (Impella) and describes a practical approach to optimize care for patients with cardiogenic shock.
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