Skip to main content
main-content

Tipp

Weitere Artikel dieser Ausgabe durch Wischen aufrufen

Erschienen in: Wiener klinische Wochenschrift 3-4/2020

16.01.2020 | short report

Impella®: an updated meta-analysis of available data and future outlook on applications in cardiogenic shock

verfasst von: Bernhard Wernly, Alexander Lauten, Holger Thiele, Christian Jung

Erschienen in: Wiener klinische Wochenschrift | Ausgabe 3-4/2020

Einloggen, um Zugang zu erhalten
share
TEILEN

Excerpt

Critically ill patients admitted for cardiogenic shock (CS) suffer from a high mortality despite undergoing state of the art, guideline-driven treatment consisting of fluids, catecholamines and, if indicated, reperfusion therapy. Aiming to improve outcomes, devices tailored to increase cardiac output and peripheral perfusion were developed [ 1]. The initial high hopes in intra-aortic balloon pumping (IABP) were shattered by the IABP-SHOCK II trial which failed to show a mortality benefit for IABP over medical treatment [ 2]. Therefore, newer, more powerful devices, including Impella® (Abiomed, Denver, MA, USA) were developed and implemented [ 3, 4]. The Impella® is a microaxial flow pump that delivers blood into the ascending aorta from the LV and augments cardiac index. The Impella® reaches a flow of up to 5 L/min depending on the device. Experimental studies suggested left ventricular (LV) unloading, an increase in cardiac output and improved blood flow in the coronary arteries in Impella® patients [ 5]. Impella® is conceptually promising as it enables (depending on the device) percutaneous implantation and might decrease myocardial oxygen demand while increasing both cardiac output and organ perfusion, thereby potentially promoting neurological and renal organ protection [ 6]; however, in randomized trials Impella® showed an unfavorable risk profile (increased vascular complications and major bleeding) and did not improve mortality rates in cardiogenic shock (CS) patients [ 7, 8]. Performing trials in patients with CS is difficult, therefore, the meta-analysis comparing “Impella®” versus medical treatment and/or IABP in CS patients was updated [ 9]. …
Literatur
1.
Zurück zum Zitat Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35(3):156–67. CrossRef Werdan K, Gielen S, Ebelt H, Hochman JS. Mechanical circulatory support in cardiogenic shock. Eur Heart J. 2014;35(3):156–67. CrossRef
2.
Zurück zum Zitat Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013;382(9905):1638–45. CrossRef Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013;382(9905):1638–45. CrossRef
3.
Zurück zum Zitat Ouweneel DM, de Brabander J, Karami M, Sjauw KD, Engstrom AE, Vis MM et al. Real-life use of left ventricular circulatory support with Impella in cardiogenic shock after acute myocardial infarction: 12 years AMC experience. Eur Heart J Acute Cardiovasc Care. 2019;8(4):338–49. CrossRef Ouweneel DM, de Brabander J, Karami M, Sjauw KD, Engstrom AE, Vis MM et al. Real-life use of left ventricular circulatory support with Impella in cardiogenic shock after acute myocardial infarction: 12 years AMC experience. Eur Heart J Acute Cardiovasc Care. 2019;8(4):338–49. CrossRef
4.
Zurück zum Zitat Jensen PB, Kann SH, Veien KT, Moller-Helgestad OK, Dahl JS, Rud CS, et al. Single-centre experience with the Impella CP, 5.0 and RP in 109 consecutive patients with profound cardiogenic shock. Eur Heart J Acute Cardiovasc Care. 2018;7(1):53–61. CrossRef Jensen PB, Kann SH, Veien KT, Moller-Helgestad OK, Dahl JS, Rud CS, et al. Single-centre experience with the Impella CP, 5.0 and RP in 109 consecutive patients with profound cardiogenic shock. Eur Heart J Acute Cardiovasc Care. 2018;7(1):53–61. CrossRef
5.
Zurück zum Zitat Remmelink M, Sjauw KD, Henriques JP, de Winter RJ, Koch KT, van der Schaaf RJ, et al. Effects of left ventricular unloading by Impella recover LP2.5 on coronary hemodynamics. Catheter Cardiovasc Interv. 2007;70(4):532–7. CrossRef Remmelink M, Sjauw KD, Henriques JP, de Winter RJ, Koch KT, van der Schaaf RJ, et al. Effects of left ventricular unloading by Impella recover LP2.5 on coronary hemodynamics. Catheter Cardiovasc Interv. 2007;70(4):532–7. CrossRef
6.
Zurück zum Zitat Markus B, Patsalis N, Chatzis G, Luesebrink U, Ahrens H, Schieffer B, et al. Impact of microaxillar mechanical left ventricular support on renal resistive index in patients with cardiogenic shock after myocardial infarction: a pilot trial to predict renal organ dysfunction in cardiogenic shock. Eur Heart J Acute Cardiovasc Care. 2019; https://​doi.​org/​10.​1177/​2048872619860218​. CrossRefPubMed Markus B, Patsalis N, Chatzis G, Luesebrink U, Ahrens H, Schieffer B, et al. Impact of microaxillar mechanical left ventricular support on renal resistive index in patients with cardiogenic shock after myocardial infarction: a pilot trial to predict renal organ dysfunction in cardiogenic shock. Eur Heart J Acute Cardiovasc Care. 2019; https://​doi.​org/​10.​1177/​2048872619860218​. CrossRefPubMed
7.
Zurück zum Zitat Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L, Byrne R, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52(19):1584–8. CrossRef Seyfarth M, Sibbing D, Bauer I, Frohlich G, Bott-Flugel L, Byrne R, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52(19):1584–8. CrossRef
8.
Zurück zum Zitat Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ et al. Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol. 2017;69(3):278–87. CrossRef Ouweneel DM, Eriksen E, Sjauw KD, van Dongen IM, Hirsch A, Packer EJ et al. Percutaneous mechanical circulatory support versus intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. J Am Coll Cardiol. 2017;69(3):278–87. CrossRef
11.
Zurück zum Zitat Karatolios K, Chatzis G, Markus B, Luesebrink U, Ahrens H, Dersch W et al. Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest. Resuscitation. 2018;126:104–10. CrossRef Karatolios K, Chatzis G, Markus B, Luesebrink U, Ahrens H, Dersch W et al. Impella support compared to medical treatment for post-cardiac arrest shock after out of hospital cardiac arrest. Resuscitation. 2018;126:104–10. CrossRef
12.
Zurück zum Zitat Schrage B, Ibrahim K, Loehn T, Werner N, Sinning JM, Pappalardo F et al. Impella support for acute myocardial infarction complicated by cardiogenic shock. Circulation. 2019;139(10):1249–58. CrossRef Schrage B, Ibrahim K, Loehn T, Werner N, Sinning JM, Pappalardo F et al. Impella support for acute myocardial infarction complicated by cardiogenic shock. Circulation. 2019;139(10):1249–58. CrossRef
13.
Zurück zum Zitat Alushi B, Douedari A, Froehlig G, Knie W, Wurster TH, Leistner DM et al. Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock. Open Heart. 2019;6(1):e987. CrossRef Alushi B, Douedari A, Froehlig G, Knie W, Wurster TH, Leistner DM et al. Impella versus IABP in acute myocardial infarction complicated by cardiogenic shock. Open Heart. 2019;6(1):e987. CrossRef
14.
Zurück zum Zitat Flaherty MP, Khan AR, O’Neill WW. Early initiation of Impella in acute myocardial infarction complicated by cardiogenic shock improves survival: a meta-analysis. JACC Cardiovasc Interv. 2017;10(17):1805–6. CrossRef Flaherty MP, Khan AR, O’Neill WW. Early initiation of Impella in acute myocardial infarction complicated by cardiogenic shock improves survival: a meta-analysis. JACC Cardiovasc Interv. 2017;10(17):1805–6. CrossRef
16.
Zurück zum Zitat Esposito ML, Zhang Y, Qiao X, Reyelt L, Paruchuri V, Schnitzler GR et al. Left ventricular unloading before reperfusion promotes functional recovery after acute myocardial infarction. J Am Coll Cardiol. 2018;72(5):501–14. CrossRef Esposito ML, Zhang Y, Qiao X, Reyelt L, Paruchuri V, Schnitzler GR et al. Left ventricular unloading before reperfusion promotes functional recovery after acute myocardial infarction. J Am Coll Cardiol. 2018;72(5):501–14. CrossRef
17.
Zurück zum Zitat Kapur NK, Alkhouli MA, DeMartini TJ, Faraz H, George ZH, Goodwin MJ et al. Unloading the left ventricle before reperfusion in patients with anterior ST-segment-elevation myocardial infarction. Circulation. 2019;139(3):337–46. CrossRef Kapur NK, Alkhouli MA, DeMartini TJ, Faraz H, George ZH, Goodwin MJ et al. Unloading the left ventricle before reperfusion in patients with anterior ST-segment-elevation myocardial infarction. Circulation. 2019;139(3):337–46. CrossRef
18.
Zurück zum Zitat Udesen NJ, Moller JE, Lindholm MG, Eiskjaer H, Schafer A, Werner N et al. Rationale and design of DanGer shock: Danish-German cardiogenic shock trial. Am Heart J. 2019;214:60–8. CrossRef Udesen NJ, Moller JE, Lindholm MG, Eiskjaer H, Schafer A, Werner N et al. Rationale and design of DanGer shock: Danish-German cardiogenic shock trial. Am Heart J. 2019;214:60–8. CrossRef
19.
Zurück zum Zitat Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engstrom AE, Lagrand WK, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med. 2016;42(12):1922–34. CrossRef Ouweneel DM, Schotborgh JV, Limpens J, Sjauw KD, Engstrom AE, Lagrand WK, et al. Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med. 2016;42(12):1922–34. CrossRef
20.
Zurück zum Zitat Thiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J. 2019;40(32):2671–83. CrossRef Thiele H, Ohman EM, de Waha-Thiele S, Zeymer U, Desch S. Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J. 2019;40(32):2671–83. CrossRef
22.
Zurück zum Zitat Masyuk M, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig JM et al. Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med. 2019;45(1):55–61. CrossRef Masyuk M, Wernly B, Lichtenauer M, Franz M, Kabisch B, Muessig JM et al. Prognostic relevance of serum lactate kinetics in critically ill patients. Intensive Care Med. 2019;45(1):55–61. CrossRef
Metadaten
Titel
Impella®: an updated meta-analysis of available data and future outlook on applications in cardiogenic shock
verfasst von
Bernhard Wernly
Alexander Lauten
Holger Thiele
Christian Jung
Publikationsdatum
16.01.2020
Verlag
Springer Vienna
Erschienen in
Wiener klinische Wochenschrift / Ausgabe 3-4/2020
Print ISSN: 0043-5325
Elektronische ISSN: 1613-7671
DOI
https://doi.org/10.1007/s00508-019-01600-0