Journal article
Clinical outcomes among cardiogenic shock patients supported with high-capacity Impella axial flow pumps: A report from the Cardiogenic Shock Working Group
The Journal of heart and lung transplantation, v 43(9), pp 1478-1488
01 Sep 2024
PMID: 38834162
Featured in Collection : UN Sustainable Development Goals @ Drexel
Abstract
The Impella 5.0 and 5.5 pumps (Abiomed, Danvers, MA) are large-bore transvalvular micro-axial assist devices used in cardiogenic shock (CS) for patients requiring high-capacity flow. Despite their increasing use, real-world data regarding indications, rates of utilization and clinical outcomes with this therapy are limited. The objective of our study was to examine clinical profiles and outcomes of patients in a contemporary, real-world CS registry of patients who received an Impella 5.0/5.5 alone or in combination with other temporary mechanical circulatory support (tMCS) devices.
The CS Working Group (CSWG) Registry includes patients from 34 US hospitals. For this analysis, data from patients who received an Impella 5.0/5.5 between 2020–2023 were analyzed. Use of Impella 5.0/5.5 with or without additional tMCS therapies, duration of support, adverse events and outcomes at hospital discharge were studied. Adverse events including stroke, limb ischemia, bleeding and hemolysis were not standardized by the registry but reported per individual CSWG Primary Investigator discretion. For those who survived, rates of native heart recovery (NHR) or heart replacement therapy (HRT) including heart transplant (HT), or durable ventricular assist device (VAD) were recorded. We also assessed outcomes based on shock etiology (acute myocardial infarction or MI-CS vs. heart failure-related CS or HF-CS).
Among 6,205 patients, 754 received an Impella 5.0/5.5 (12.1%), including 210 MI-CS (27.8%) and 484 HF-CS (64.1%) patients. Impella 5.0/5.5 was used as the sole tMCS device in 32% of patients, while 68% of patients received a combination of tMCS devices. Impella cannulation sites were available for 524/754 (69.4%) of patients, with 93.5% axillary configuration. Survival to hospital discharge for those supported with an Impella 5.0/5.5 was 67%, with 20.4% NHR and 45.5% HRT. Compared to HF-CS, patients with MI-CS supported on Impella 5.0/5.5 had higher in-hospital mortality (45.2% vs 26.2%, p < 0.001) and were less likely to receive HRT (22.4% vs 56.6%, p < 0.001. For patients receiving a combination of tMCS during hospitalization, this was associated with higher rates of limb ischemia (9% vs. 3%, p < 0.01), bleeding (52% vs 33%, p < 0.01), and mortality (38% vs 25%; p < 0.001) compared to Impella 5.0/5.5 alone. Among Impella 5.0/5.5 recipients, the median duration of pump support was 12.9 days (IQR: 6.8–22.9) and longer in patients bridged to HRT (14 days; IQR: 7.7–28.4).
In this multi-center cohort of patients with CS, use of Impella 5.0/5.5 was associated with an overall survival of 67.1% and high rates of HRT. Lower adverse event rates were observed when Impella 5.0/5.5 was the sole support device used. Further study is required to determine whether a strategy of early Impella 5.0/5.5 use for CS improves survival.
High capacity Impella heart pumps are capable of provide up to 5.5 liter/min of flow while upper body surgical placement allows for ambulation. Patients with advanced cardiogenic shock from acute myocardial infarction or heart failure requiring temporary mechanical circulatory support may benefit from upfront use of Impella 5.5 to improve overall survival, including native heart recovery or successful bridge to durable left ventricular assist device surgery or heart transplantation.
Metrics
Details
- Title
- Clinical outcomes among cardiogenic shock patients supported with high-capacity Impella axial flow pumps: A report from the Cardiogenic Shock Working Group
- Creators
- Justin Fried - Columbia University Irving Medical CenterMaryjane Farr - The University of Texas Southwestern Medical CenterManreet Kanwar - Allegheny Health NetworkNir Uriel - Columbia University Irving Medical CenterJaime Hernandez-Montfort - Division of Cardiology, Baylor Scott and White Health, Temple, TexasVanessa Blumer - Inova Design SolutionsSong Li - Medical City Dallas HospitalShashank S. Sinha - Inova Design SolutionsA. Reshad Garan - Beth Israel Deaconess Medical CenterBorui Li - Tufts Medical CenterShelley Hall - Baylor University Medical CenterGavin W. Hickey - University of Pittsburgh Medical CenterClaudius Mahr - Medical City Dallas HospitalSandeep Nathan - University of ChicagoAndrew Schwartzman - Maine Medical CenterJu Kim - Houston MethodistVan-Khue Ton - Massachusetts General HospitalOleg A. Vishnevsky - Thomas Jefferson University HospitalEsther Vorovich - Northwestern MedicineJacob Abraham - Hope Heart InstituteElric Zweck - Heinrich Heine University DüsseldorfMaya Guglin - Indiana University – Purdue University IndianapolisSaraschandra Vallabhajosyula - Cardiovascular Institute of the SouthRachna Kataria - LifespanKarol D. Walec - Tufts Medical CenterPeter Zazzali - Tufts Medical CenterQiuyue Kong - Tufts Medical CenterPaavani Sangal - Tufts Medical CenterDaniel Burkhoff - Cardiovascular Research FoundationNavin K. Kapur - Tufts Medical Center
- Publication Details
- The Journal of heart and lung transplantation, v 43(9), pp 1478-1488
- Publisher
- Elsevier
- Number of pages
- 11
- Resource Type
- Journal article
- Language
- English
- Academic Unit
- Cardiology
- Web of Science ID
- WOS:001296529700001
- Scopus ID
- 2-s2.0-85196798808
- Other Identifier
- 991021932105904721
UN Sustainable Development Goals (SDGs)
This publication has contributed to the advancement of the following goals:
InCites Highlights
Data related to this publication, from InCites Benchmarking & Analytics tool:
- Collaboration types
- Domestic collaboration
- International collaboration
- Web of Science research areas
- Cardiac & Cardiovascular Systems
- Respiratory System
- Surgery
- Transplantation