Key result
Bedside TEE-guided Impella 2.5 placement alongside IABP is linked to hemodynamic recovery in cardiogenic shock.
Why the study?
Cardiogenic shock refractory to pharmacological and intra-aortic balloon pump support remains a significant cause of morbidity and mortality, with challenges in device placement due to hemodynamic instability.
Case Report (n=1)
Bedside TEE-guided placement of an Impella 2.5 device is a feasible and potentially life-saving strategy for patients with profound cardiogenic shock who are too unstable for transport to the catheterization lab.
Supports feasibility of bedside TEE-guided Impella in profound shock; hypothesis-generating and should not yet change practice.
Cardiogenic shock (CS) remains a significant cause of in-hospital morbidity and mortality despite frequent use of mechanical circulatory devices, i.e., intra-aortic balloon pump (IABP) and Impella 2.5 (IMP), which are now considered a standard of care for treatment of severe CS refractory to pharmacological treatment. Herein, we present a challenging case of severe CS refractory to pharmacological and IABP support, where IMP was utilized in combination with IABP. IMP was inserted at bedside under transesophageal echocardiography (TEE) guidance giving the patient’s hemodynamic instability, which had prevented transportation to the catheterization lab. After this treatment strategy, the patient showed significant hemodynamic and clinical improvement, followed by weaning off pharmacological and mechanical support and was eventually discharged home.
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Enezate et al. (2016) conducted a case report in Severe cardiogenic shock (n=1). Impella 2.5 L placement under transesophageal echocardiography (TEE) guidance was evaluated on Hemodynamic and clinical improvement. Bedside placement of Impella 2.5 under TEE guidance in a patient with profound cardiogenic shock already on IABP resulted in significant hemodynamic improvement and hospital discharge.
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