Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis

Panuccio, Giuseppe; Neri, Giuseppe; Macrì, Lucrezia Maria; Salerno, Nadia; Rosa, Salvatore De; Torella, Daniele

doi:10.1016/j.ijcha.2022.101007

Cited by 24 publications

(32 citation statements)

References 26 publications

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“…In addition, optimal timing regarding concomitant Impella implantation might play a crucial role in patients’ survival [ 20 ]. Moreover, authors have mentioned that sufficient device sizing and convenient patient selection could reduce a complication rate and improve outcomes [ 21 ].…”

Section: Discussionmentioning

confidence: 99%

ECMO Retrieval Program: What Have We Learned So Far

Krasivskyi

Großmann

Dechow

et al. 2023

Life

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Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used for patients with cardiogenic shock or cardiac arrest. However, survival rates remain low. It is unclear to what extent ECMO patients benefit from the ECMO team learning curve. Therefore, we aimed to analyze our mobile ECMO program patients from the past seven years to evaluate if a learning curve benefits patients’ outcomes. We analyzed 111 patients from our databank who were supported with a VA-ECMO and brought to our hospital from January 2015 to December 2021. Patients were divided into two groups: survival (n = 70) and non-survival (n = 41). As expected, complications after ECMO implantation were more severe in the non-survivor group. The incidence of thromboembolic events (p = 0.002), hepatic failure (p < 0.001), renal failure (p = 0.002), dialysis (p = 0.002) and systemic inflammatory response syndrome (SIRS, p = 0.044) occurred significantly more often compared with the survivor group. We were able to show that despite our extensive experience in terms of ECMO retrieval program the high mortality and morbidity rates stay fairly the same over the years. This displays that we have to focus even more on patient selection and ECMO indication.

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Section: Discussionmentioning

confidence: 99%

ECMO Retrieval Program: What Have We Learned So Far

Krasivskyi

Großmann

Dechow

et al. 2023

Life

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show abstract

“…However, femoral Impella has been reported to significantly higher complications such as bleeding, ischemia, and hemolysis especially when high P level is used, and higher incidence of sepsis. [8][9][10] Furthermore, with increased duration of support there is risk of access site infection and sepsis. 8 The axillary Impella 5.5 offers many advantages, such as higher pump flow, fewer complications including vascular complications, hemolysis, and less issues with placement and positioning due to its design such as shorter catheter, absence of pigtail compared to CP, and larger but shorter pump compared to Impella 5.0.…”

Section: Discussionmentioning

confidence: 99%

“…Impella 2.5 and CP are commonly used in patients presenting with CS due to the ease of percutaneous insertion via the femoral artery. However, femoral Impella has been reported to significantly higher complications such as bleeding, ischemia, and hemolysis especially when high P level is used, and higher incidence of sepsis 8–10 . Furthermore, with increased duration of support there is risk of access site infection and sepsis 8 .…”

Section: Discussionmentioning

confidence: 99%

Evolution of concomitant use of veno‐arterial extracorporeal membrane oxygenation support with Impella in cardiogenic shock: From percutaneous femoral Impella to axillary Impella 5.5

et al. 2023

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BackgroundLittle is known about safety and efficacy of the use of Impella 5.5 compared to previous iterations in the setting of Impella with Veno‐Arterial Extracorporeal Membrane Oxygenation Support as ECPELLA.MethodsConsecutive patients who were treated by ECPELLA with surgically implanted axillary Impella 5.5 (N = 13) were compared with patients supported by ECPELLA with percutaneous femoral Impella CP or 2.5 (Control, N = 13).ResultsThe total ECPELLA flow was higher in ECPELLA 5.5 group (6.9 vs. 5.4 L/min, p = 0.019). Actual hospital survival was higher than predicted and comparable in both groups (ECPELLA 5.5, 61.5% vs. Control, 53.8%, p = 0.691). Both total device complications (ECPELLA 5.5, 7.7% vs. Control, 46.1%, p = 0.021) and Impella‐specific complications (ECPELLA 5.5, 0% vs. Control, 30.8%, p = 0.012) were significantly lower in the ECPELLA 5.5 group.ConclusionsUtilization of Impella 5.5 in the setting of ECPELLA provides greater hemodynamic support with a lower risk of complications compared to Impella CP or 2.5.

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“…Though our patient was found to have a stable small retroperitoneal bleed and inguinal hematoma at the site of the previously placed IABP, we were able to effectively manage conservatively without additional complications. Studies have also demonstrated that older age and severe comorbidities can be associated with a higher risk of vascular complications [ 43 ]. Therefore, bridging the patient out to at least 3–4 weeks post-VSR to obtain surgical tissue quality must be weighed against the risk of MCS-related complications.…”

Section: Discussionmentioning

confidence: 99%

ECMO and Impella Support Strategies as a Bridge to Surgical Repair of Post-Infarction Ventricular Septal Rupture

et al. 2022

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Background and Objectives: Post-infarct ventricular septal rupture (PIVSR) continues to have significant morbidity and mortality, despite decreased prevalence. Impella and venoarterial extracorporeal membranous oxygenation (VA-ECMO) have been proposed as strategies to correct hemodynamic derangements and bridge patients to delayed operative repair when success rates are higher. This review places VA-ECMO and Impella support strategies in the context of bridging patients to successful PIVSR repair, with an additional case report of successful bridging with the Impella device. Materials and Methods: We report a case of PIVSR repair utilizing 14 days of Impella support. We additionally conducted a systematic review of contemporary literature to describe the application of VA-ECMO and Impella devices in the pre-operative period prior to surgical PIVSR correction. Expert commentary on the advantages and disadvantages of each of these techniques is provided. Results: We identified 19 studies with 72 patients undergoing VA-ECMO as a bridge to PIVSR repair and 6 studies with 11 patients utilizing an Impella device as a bridge to PIVSR repair. Overall, outcomes in both groups were better than expected from patients who were historically managed with medicine and balloon pump therapy, however there was a significant heterogeneity between studies. Impella provided for excellent left ventricular unloading, but did result in some concerns for reversal of shunting. VA-ECMO resulted in improved end-organ perfusion, but carried increased risks of device-related complications and requirement for additional ventricular unloading. Conclusions: Patients presenting with PIVSR in cardiogenic shock requiring a MCS bridge to definitive surgical repair continue to pose a challenge to the multidisciplinary cardiovascular team as the diverse presentation and management issues require individualized care plans. Both VA-ECMO and the Impella family of devices play a role in the contemporary management of PIVSR and offer distinct advantages and disadvantages depending on the clinical scenario. The limited case numbers reported demonstrate feasibility, safety, and recommendations for optimal management.

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Use of Impella device in cardiogenic shock and its clinical outcomes: A systematic review and meta-analysis

Cited by 24 publications

References 26 publications

ECMO Retrieval Program: What Have We Learned So Far

ECMO Retrieval Program: What Have We Learned So Far

Evolution of concomitant use of veno‐arterial extracorporeal membrane oxygenation support with Impella in cardiogenic shock: From percutaneous femoral Impella to axillary Impella 5.5

ECMO and Impella Support Strategies as a Bridge to Surgical Repair of Post-Infarction Ventricular Septal Rupture

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