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

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]. …