Immediate Impella 5.0 support (33.3% survival) or upgrading from 2.5 to 5.0 (37.5%) suggested improved 30-day survival compared to Impella 2.5 support alone (17.6%) in cardiogenic shock.
Observational (n=34)
No
Does the Impella 5.0 device improve survival compared to the Impella 2.5 device in ST-elevation myocardial infarction patients with profound cardiogenic shock?
In STEMI patients with profound cardiogenic shock, initial experience suggests immediate or upgraded use of the Impella 5.0 device may improve survival compared to the Impella 2.5 device alone.
Absolute Event Rate: 33.3% vs 24%
OBJECTIVE: Cardiogenic shock remains an important therapeutic challenge, with high in-hospital mortality rates. Mechanical circulatory support may be beneficial in these patients. Since the efficacy of the intra-aortic balloon pump seems limited, new percutaneously placed mechanical left ventricular support devices, such as the Impella system, have been developed for this purpose. Our current purpose was to describe our experience with the Impella system in patients with ST-elevation myocardial infarction presenting in profound cardiogenic shock, who were admitted to our intensive care unit for mechanical ventilation. METHODS: From January 2004 through August 2010, a total of 34 ST-elevation myocardial infarction patients with profound cardiogenic shock were admitted to our intensive care unit and treated with either the Impella 2.5 or the Impella 5.0 device. Baseline and follow-up characteristics were collected retrospectively. MEASUREMENTS AND MAIN RESULTS: Within the study cohort, 25 patients initially received treatment with the Impella 2.5, whereas nine patients received immediate Impella 5.0 support. Eight out of 25 patients in the Impella 2.5 group were upgraded to 5.0 support. After 48 hrs, 14 of 25 patients in the 2.5 group were alive, five of whom had been upgraded. In the 5.0 group, eight out of nine patients were alive. After 30 days, six of 25 patients in the 2.5 group were alive, three of whom had been upgraded. In the 5.0 group, three of nine patients were alive at 30 days. CONCLUSIONS: In ST-elevation myocardial infarction patients with severe and profound cardiogenic shock, our initial experience suggests improved survival in patients who received immediate Impella 5.0 treatment, as well as in patients who were upgraded from 2.5 to 5.0 support, when compared to patients who received only Impella 2.5 support.
Engström et al. (2011) conducted an observational in ST-elevation myocardial infarction with profound cardiogenic shock (n=34). Impella 5.0 vs. Impella 2.5 was evaluated on Survival at 30 days. Immediate Impella 5.0 support (33.3% survival) or upgrading from 2.5 to 5.0 (37.5%) suggested improved 30-day survival compared to Impella 2.5 support alone (17.6%) in cardiogenic shock.