The Therapeutic Use of Impella Device in Cardiogenic Shock: A Systematic Review

Abstract

Impella (Abiomed, Danvers, MA) devices nowadays have been linked to cardiogenic shock (CS) due to the importance of their use as therapeutic instruments. This study aims to review pathophysiologic mechanisms of cardiogenic shock and the implementation of Impella to overcome this condition. To investigate several different types of studies and analyze the use of Impella device in cardiogenic shock and the outcomes of heart malfunctioning and determine its positive and negative impacts as a therapeutic tool in cardiac ischemia and use as a resource in critical patients, we conducted a systematic review through different databases (PubMed, ScienceDirect, and Google Scholar) following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) checklist and used the Medical Subjects Heading (MeSH) search strategy to obtain significant articles. We found 883 papers in total, and after removing duplicates, applying inclusion/exclusion criteria, and finding the most significant information, we ended up with 30 articles that were reviewed containing information about the impact of Impella device in cardiogenic shock in different locations. The study strongly concludes that Impella device in the setting of cardiogenic shock has more advantages than disadvantages in terms of outcomes and complications as a non-pharmacologic tool. Improvements in left ventricular ejection fraction and signs and symptoms of cardiogenic shock criteria were determinants. Nevertheless, complications during the implementation and use of the device were established; in this manner, the evaluation and treatment of each patient separately are imperative. Consequently, more studies on this relevant topic are needed.

Registro multicéntrico Impella CP para shock cardiogénico o angioplastía de alto riesgo protegida en Chile

“…Una serie de revisiones sistemáticas se han centrado en evaluar los efectos del dispositivo Impella CP* en la reducción de la mortalidad y desenlaces clínicos de los pacientes 2,4,5 . Dichas revisiones han mostrado que la mayoría de estudios evaluando el dispositivo Impella son estudios retrospectivos con muestras relativamente pequeñas 2 .…”

“…3 El dispositivo mejora la presión arterial, descomprime el ventrículo izquierdo disminuyendo su trabajo, aumenta la frecuencia cardíaca y está asociado a una baja tasa de eventos adversos. 4 En Latino América, existen pocos estudios evaluando la eficacia de los dispositivos de soporte circulatorio mecánico. En el caso de Chile, no existen estudios eva-…”

The Use of Cardioprotective Devices and Strategies in Patients Undergoing Percutaneous Procedures and Cardiac Surgery

“…Different models are available depending on the supply they provide: Impella 2.5 (2.5 L/min flow), Impella CP (4 L/min flow), and Impella 5.0 (5 L/min flow) [ 8 ]. A recent systematic review conducted by Munoz et al demonstrated the efficacy of the Impella device in improving survival in cardiogenic shock despite the etiology [ 9 ]. Moreover, this device has been demonstrated to increase coronary microcirculation while lowering the workload burden in the left ventricle [ 9 ].…”

“…A recent systematic review conducted by Munoz et al demonstrated the efficacy of the Impella device in improving survival in cardiogenic shock despite the etiology [ 9 ]. Moreover, this device has been demonstrated to increase coronary microcirculation while lowering the workload burden in the left ventricle [ 9 ]. When comparing the management of the Impella device with IABP in acute myocardial infarction-related cardiogenic shock, the Impella device showed better outcomes, as there was a lower amount of troponins and creatine phosphokinase when using the Impella device [ 73 ].…”

“…There exist many devices to curb the adverse effects and prevalence of cardiac procedure-related injuries. These devices act at different levels; either providing or improving hemodynamic support such as TandemHeart, Impella family devices, veno-arterial extracorporeal membrane oxygenation (VA-ECMO), intra-aortic balloon pump (IABP), etc; or by inducing cardioplegia, thus preserving myocardial properties such as topic cardioprotective cooling devices [ 8 , 9 , 10 , 11 ]. Although these devices and approaches have shown some promising results and are currently widely used for treating other conditions such as the use of VA-ECMO in respiratory failure, their uses in treating or preventing hemodynamic alterations in regard to cardiac surgery or percutaneous interventions still bear some important adverse effects that do not permit diminish of mortality in high-risk patients undergoing cardiac surgery or percutaneous interventions [ 12 , 13 , 14 , 15 , 16 ].…”