Real-life use of left ventricular circulatory support with Impella in cardiogenic shock after acute myocardial infarction: 12 years AMC experience

Abstract

Aims: Mortality in cardiogenic shock patients remains high. Short-term mechanical circulatory support with Impella can be used to support the circulation in these patients, but data from randomised controlled studies and ‘real-world’ data are sparse. The aim is to describe real-life data on outcomes and complications of our 12 years of clinical experience with Impella in patients with cardiogenic shock after acute myocardial infarction and to identify predictors of 6-month mortality. Methods: We describe a single-centre registry from October 2004 to December 2016 including all patients treated with Impella for cardiogenic shock after acute myocardial infarction. We report outcomes and complications and identify predictors of 6-month mortality. Results: Our overall clinical experience consists of 250 patients treated with Impella 2.5, Impella CP or Impella 5.0. A total of 172 patients received Impella therapy for cardiogenic shock, of which 112 patients had cardiogenic shock after acute myocardial infarction. The mean age was 60.1±10.6 years, mean arterial pressure was 67 (56–77) mmHg, lactate was 6.2 (3.6–9.7) mmol/L, 87.5% were mechanically ventilated and 59.6% had a cardiac arrest before Impella placement. Overall 30-day mortality was 56.2% and 6-month mortality was 60.7%. Complications consisted of device-related vascular complications (17.0%), non-device-related bleeding (12.5%), haemolysis (7.1%) and stroke (3.6%). In a multivariate analysis, pH before Impella placement is a predictor of 6-month mortality. Conclusions: Our registry shows that Impella treatment in cardiogenic shock after acute myocardial infarction is feasible, although mortality rates remain high and complications occur.

Comparison of mechanical circulatory support with venoarterial extracorporeal membrane oxygenation or Impella for patients with cardiogenic shock: a propensity-matched analysis

“…However, as expected access-site complications occurred more frequently in the vaECMO group than in the Impella group. This finding is in line with previous investigations [14][15][16]. Recently, a large-scale propensity-matched, registry-based retrospective cohort study observational including 1768 patients with CS treated with Impella reported high rates of major bleeding of 31.3% [17], which was markedly higher compared to the bleeding rates in our Impella cohort.…”

Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis

“…The possibility of reducing the duration of ECLS has been reported by Scharge et al [50], however, in the experience of Pappalardo et al [48], the association of Impella and VA-ECMO prolonged the time of support but provided a successful recovery of patients who might not have survived under VA-ECMO treatment alone. The use of Impella has been associated with a significant risk of severe bleeding, vascular complications and cerebral stroke [53,54]. In patients receiving the dual treatment with VA-ECMO, a higher occurrence of hemolysis has been reported [48], however, no difference was generally found in terms of risk of major and minor bleeding, and cerebral stroke compared to VA-ECMO alone [47,49].…”

Haemodynamic efficacy of microaxial left ventricular assist device in cardiogenic shock: a systematic review and meta-analysis

“…On the other hand, real-world data are refractory. In the 12-year experience of the Amsterdam Medical Centre there was no significant improvement of survival when support was initiated before PCI [35].…”