The Impella percutaneous mechanical circulatory support device is designed to augment cardiac output and reduce left ventricular wall stress and aims to improve survival in cases of cardiogenic shock. In this meta-analysis we investigated the haemodynamic effects of the Impella device in a clinical setting. We systematically searched all articles in PubMed/ Medline and Embase up to July 2019. The primary outcomes were cardiac power (CP) and cardiac power index (CPI). Survival rates and other haemodynamic data were included as secondary outcomes. For the critical appraisal, we used a modified version of the U.S. Department of Health and Human Services quality assessment form. The systematic review included 12 studies with a total of 596 patients. In 258 patients the CP and/or CPI could be extracted. Our meta-anal-D.I.M. van Dort and K.R.A.H. Peij contributed equally to this manuscript. ysis showed an increase of 0.39 W [95% confidence interval (CI): 0.24, 0.54], (p = 0.01) and 0.22 W/m 2 (95% CI: 0.18, 0.26), (p < 0.01) for the CP and CPI, respectively. The overall survival rate was 56% (95% CI: 0.50, 0.62), (p = 0.09). The quality of the studies was moderate, mostly due to the presence of confounders. Our study suggests that in patients with cardiogenic shock, Impella support seems effective in augmenting CP(I). This study merely investigates the haemodynamic effectiveness of the Impella device and does not reflect the complete clinical impact for the patient. Review Article ConclusionOur meta-analysis shows that short-term MCS with the Impella device is effective in increasing CP and CPI. Despite successfully increased CP with Impella support, the mortality seems to be in line with the survival rate without Impella use.

Background: We recently demonstrated that a novel intra-ventricular membrane pump (IVMP) was able to increase the pump function of isolated beating porcine hearts. In follow-up, we now investigated the impact of the IVMP on myocardial oxygen consumption and total mechanical efficiency (TME) and assessed the effect of IVMP-support in acutely failing hearts. Methods: In 10 ex vivo beating porcine hearts, we studied hemodynamic parameters, as well as arterial and coronary venous oxygen content. We assessed cardiac power (CP), myocardial oxygen consumption (MVO2), and TME (CP divided by MVO2) under baseline conditions and during IVMP-support. Additionally, five isolated hearts were subjected to global hypoxia to investigate the effects of IVMP-support on CP under conditions of acute heart failure. Results: Under physiological conditions, baseline CP was 0.36 ± 0.10 W, which increased to 0.65 ± 0.16 W during IVMP-support (increase of 85% ± 24, p < 0.001). This was accompanied by an increase in MVO2 from 18.6 ± 6.2 ml/min at baseline, to 22.3 ± 5.0 ml/min during IVMP-support (+26 ± 31%, p = 0.005). As a result, TME (%) increased from 5.9 ± 1.2 to 8.8 ± 1.8 (50 ± 22% increase, p < 0.001). Acute hypoxia-induced cardiac pump failure reduced CP by 35 ± 6%, which was fully restored to baseline levels during IVMP-support in all hearts. Conclusion: IVMP-support improved mechanical efficiency under physiological conditions, as the marked increase in cardiac performance only resulted in a modest increase in oxygen consumption. Moreover, the IVMP rapidly restored cardiac performance under conditions of acute pump failure. These observations warrant further study, to evaluate the effects of IVMP-support in in vivo animal models of acute cardiac pump failure.

BACKGROUND During cardiogenic shock (CS) coronary perfusion is compromised, causing a further reduction in cardiac output (CO). 1 The compromised hemodynamic state leads to a cascade of pro-inflammatory cytokine release, multiple organ failure, and eventually death. To avert the downward spiral of CS, short-term mechanical support devices have been used. 2 Despite a plethora of mechanical support devices, CS continues to have a very poor outcome with a reported mortality rate as high as 50%. 3-5 All currently available support devices deliver a nonphysiological flow, which potentially limits their efficacy. The Impella (Abiomed; Danvers, MA, USA) delivers an antegrade continuous flow, while pulsatile flow may have positive effects on organ perfusion, especially in the early phase of shock. 6-9 The intra-aortic balloon pump (IABP) uses counter-pulsatile support with passive unloading, with

Background Sealants are used to prevent prolonged pulmonary air leakage (PAL) after lung resections (incidence 5.6–30%). However, clinical evidence to support sealant use is insufficient, with an unmet need for a more effective product. We compared a novel gelatin patch impregnated with functionalized polyoxazolines (NHS-POx) (GATT-Patch) to commercially available sealant products. Methods GATT-Patch Single/Double layers were compared to Progel ® , Coseal ® , Hemopatch ® and TachoSil ® in an ex vivo porcine lung model (first experiment). Based on these results, a second head-to-head comparison between GATT-Patch Single and Hemopatch ® was performed. Air leakage (AL) was assessed in three settings using increasing ventilatory pressures (max =70 cmH 2 O): (I) baseline, (II) with 25 mm × 25 mm superficial pleural defect, and (III) after sealant application. Lungs floating on saline (37 ℃) were video recorded for visual AL assessment. Pressure and tidal volumes were collected from the ventilator, and bursting pressure (BP), AL and AL-reduction were determined. Results Per sealant 10 measurements were performed (both experiments). In the first experiment, BP was superior for GATT-Patch Double (60±24 cmH 2 O) compared to TachoSil ® (30±11 cmH 2 O, P<0.001), Hemopatch ® (33±6 cmH 2 O, P=0.006), Coseal ® (25±13 cmH 2 O, P=0.001) and Progel ® (33±11 cmH 2 O, P=0.005). AL-reduction was superior for GATT-Patch Double (100%±1%) compared to Hemopatch ® (46%±50%, P=0.010) and TachoSil ® (31%±29%, P<0.001), and also for GATT-Patch Single (100%±14%, P=0.004) and Progel (89%±40%, P=0.027) compared to TachoSil ® . In the second experiment, GATT-Patch Single was superior regarding BP (45±10 vs. 40±6 cmH 2 O, P=0.043) and AL-reduction (100%±11% vs. 68%±40%, P=0.043) when compared to Hemopatch ® . Conclusions The novel NHS-POx patch shows promise as a lung sealant, demonstrating elevated BP, good adhesive strength and a superior AL-reduction.

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