15 Impella® use in protected PCI and cardiogenic shock

Intra-aortic balloon pump (IABP) has been used for many years in high-risk PCI or cardiogenic shock. However, the support provided by IABP is limited and a major randomised controlled trial failed to demonstrate a beneficial effect.1 Impella® is a family of percutaneous mechanical circulatory support (MCS) devices that are used in protected PCI and cardiogenic shock.2 Depending on the device model, they provide a blood flow ranging from 2.5 to 5 L/min. The resulting augmented support increases mean arterial blood pressure, cardiac output and coronary flow while unloading left ventricular filling pressure to reduce myocardial oxygen demand.2 3 This is an ideal form of temporary support device for the patient. Moreover, the device is easy to set up and can be inserted very quickly to stabilise the patient. This presentation provides a review on the current data regarding the use of Impella MCS devices. References Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K; IABP-SHOCK II Trial Investigators. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012;367:1287–1296. O’Neill WW, Kleiman NS, Moses J, Henriques JP, Dixon S, Massaro J, Palacios I, Maini B, Mulukutla S, Dzavík V, Popma J, Douglas PS, Ohman M. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012;126:1717–1727. O’Neill WW, Grines C, Schreiber T, Moses J, Maini B, Dixon SR, Ohman EM. Analysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device. Am Heart J 2018;202:33–38.