Experience from a randomized controlled trial with Impella 2.5 versus IABP in STEMI patients with cardiogenic pre-shock.

Ouweneel, Dagmar M.; Engström, Annemarie E.; Sjauw, Krischan D.; Hirsch, Alexander; Hill, Jonathan; Gockel, B.; Tuseth, Vegard; Schaaf, René J. van der; Henriques, José P.S.

doi:10.1016/j.ijcard.2015.10.063

Cited by 75 publications

(65 citation statements)

References 13 publications

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“…These trial data were combined with data from a study of Impella 2.5 vs. IABP in 21 subjects with cardiogenic pre-shock. 23 The resultant meta-analysis reported no difference in mortality at 30 days (RR 0.99, [CI 0.62–1.58]; p=0.95) or 6 months (RR 1.15, [0.74–1.48]; p=0.53). 24 …”

Section: Circulatory Support Devicesmentioning

confidence: 96%

“…Alternatively, if hemodynamically tolerable, decreasing device motor speed may reduce the degree of hemolysis. 23,43,44 Data from the USpella Registry and Impella-EUROSHOCK-registry estimate the frequency of hemolysis at 5.0–10%. 25,44 Rarely, the Impella devices have been associated with LV perforation.…”

Section: Complicationsmentioning

confidence: 99%

“…In addition to small patient sample sizes, current studies have failed to detect differences in outcomes due to variance in timing of implantation, device management, and patient selection, as well as inherent difficulties in studying this population. 23,52 …”

Section: Gaps In Knowledgementioning

confidence: 99%

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Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Miller

Solomon

McAreavey

2017

Critical Care Medicine

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Objective To review temporary percutaneous mechanical circulatory support devices (pMCS) for the treatment of cardiogenic shock, including current evidence, contraindications, complications, and future directions. Data Sources A MEDLINE search was conducted with MeSH terms: cardiogenic shock, percutaneous mechanical circulatory support, extracorporeal membrane oxygenation (ECMO), Impella, and TandemHeart. Study Selection Selected publications included randomized controlled trial data and observational studies describing experience with pMCS in cardiogenic shock. Data Extraction Studies were chosen based on strength of association with and relevance to cardiogenic shock. Data synthesis Until recently, there were few options if cardiogenic shock was refractory to vasopressors or intra-aortic balloon pump (IABP) counterpulsation. Now, several pMCS devices, including Impella®, TandemHeart™, and ECMO, are more accessible. Compared with IABP, Impella provides greater hemodynamic support, but no reduction in mortality. Similarly, TandemHeart improves hemodynamic variables, but not survival. Comparative studies have been underpowered for mortality because of small sample size. Veno-arterial ECMO offers the advantage of biventricular circulatory support and oxygenation but there are significant vascular complications. Comparative studies with ECMO have not been completed. Despite lack of randomized controlled data, there has been a substantial increase in use of pMCS. Several ongoing prospective studies with larger sample sizes may provide answers, and newer devices may become smaller, easier to insert, and more effective. Conclusions Mortality from cardiogenic shock remains unacceptably high despite early coronary revascularization or other therapies. While evidence is lacking and complications rates are high, improvements and experience with pMCS may offer the prospect of better outcomes.

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Section: Circulatory Support Devicesmentioning

confidence: 96%

Section: Complicationsmentioning

confidence: 99%

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Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Miller

Solomon

McAreavey

2017

Critical Care Medicine

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“…'The IMPella versus IABP REduceS infarct Size IN STEMI patients treated with primary PCI' (IMPRESS in STEMI) trial compared IABP and Impella 2.5 in patients presenting with STEMI and cardiogenic pre-shock, undergoing to primary PCI. Due to a slow patient enrollment, the study was stopped prematurely [83]. The IMPRESS in STEMI trial confirms the difficulties to conduct trial in the setting of cardiogenic shock [83].…”

Section: Intra-aortic Balloon Counterpulsation and Stemimentioning

confidence: 95%

“…Due to a slow patient enrollment, the study was stopped prematurely [83]. The IMPRESS in STEMI trial confirms the difficulties to conduct trial in the setting of cardiogenic shock [83]. New devices are developing in order to reduce the time of positioning.…”

Section: Intra-aortic Balloon Counterpulsation and Stemimentioning

confidence: 99%

Current and novel approaches to treat patients presenting with ST elevation myocardial infarction

Mancone

Mieghem

Zijlstra

et al. 2016

Expert Review of Cardiovascular Therapy

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Introduction: Primary percutaneous coronary intervention (PCI) represents the gold-standard treatment for patients presenting with an ST-elevation myocardial infarction (STEMI). Acute myocardial infarction is a complex clinical scenario, and an appropriate therapeutic approach could be represented by a balanced integration between healthcare system and medical competence. Areas covered: In this review we discuss how a primary PCI network, and the new therapeutic options could be coupled in order to obtain improved clinical outcomes. The present report will focus on three main issues related to STEMI patients, namely, out of hospital management, primary PCI and pharmacological treatment. Expert commentary: A possible correct approach to a patient presenting a STEMI could be considered as a stepwise process, given by 5 steps: reducing the time to reperfusion; dual antiplatelet administration; radial access; new generation drug eluting stent implantation; long term management. ARTICLE HISTORY

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Mechanical assist devices for acute cardiogenic shock

Hici

Boardman

Baig

et al. 2020

Cochrane Database of Systematic Reviews

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BackgroundCardiogenic shock (CS) is a state of critical end-organ hypoperfusion due to a primary cardiac disorder. For people with refractory CS despite maximal vasopressors, inotropic support and intra-aortic balloon pump, mortality approaches 100%. Mechanical assist devices provide mechanical circulatory support (MCS) which has the ability to maintain vital organ perfusion, to unload the failing ventricle thus reduce intracardiac filling pressures which reduces pulmonary congestion, myocardial wall stress and myocardial oxygen consumption. This has been hypothesised to allow time for myocardial recovery (bridge to recovery) or allow time to come to a decision as to whether the person is a candidate for a longer-term ventricular assist device (VAD) either as a bridge to heart transplantation or as a destination therapy with a long-term VAD. ObjectivesTo assess whether mechanical assist devices improve survival in people with acute cardiogenic shock. Search methodsWe searched CENTRAL, MEDLINE (Ovid), Embase (Ovid) and Web of Science Core Collection in November 2019. In addition, we searched three trials registers in August 2019. We scanned reference lists and contacted experts in the field to obtain further information. There were no language restrictions. Selection criteriaRandomised controlled trials on people with acute CS comparing mechanical assist devices with best current intensive care management, including intra-aortic balloon pump and inotropic support. Data collection and analysisWe performed data collection and analysis according to the published protocol.Primary outcomes were survival to discharge, 30 days, 1 year and secondary outcomes included, quality of life, major adverse cardiovascular events (30 days/end of follow-up), dialysis-dependent (30 days/end of follow-up), length of hospital stay and length of intensive care unit stay and major adverse events.We used the five GRADE considerations (study limitations, consistency of e ect, imprecision, indirectness, and publication bias) to assess the quality of a body of evidence as it relates to the studies which contribute data to the meta-analyses for the prespecified outcomes Mechanical assist devices for acute cardiogenic shock (Review)

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Experience from a randomized controlled trial with Impella 2.5 versus IABP in STEMI patients with cardiogenic pre-shock.

Cited by 75 publications

References 13 publications

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

Current and novel approaches to treat patients presenting with ST elevation myocardial infarction

Mechanical assist devices for acute cardiogenic shock

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