Usefulness of Impella support in different clinical settings in cardiogenic shock

作     者：María Isabel Barrionuevo-Sánchez Albert Ariza-Solé Daniel Ortiz-Berbel JoséGonzález-Costello Joan Antoni Gómez-Hospital Victòria Lorente Oriol Alegre Isaac Llaó JoséCarlos Sánchez-Salado Josep Gómez-Lara Arnau Blasco-Lucas Josep Comin-Colet 

作者机构：Cardiology DepartmentIntensive Cardiac Care UnitBellvitge University HospitalL’Hospitalet de LlobregatBarcelonaSpain Cardiac Surgery DepartmentHeart Disease InstituteBellvitge University HospitalL’Hospitalet de LlobregatBarcelonaSpain 

出 版 物：《Journal of Geriatric Cardiology》 (老年心脏病学杂志（英文版）)

年 卷 期：2022年第19卷第2期

页      面：115-124页

核心收录：

学科分类：1002[医学-临床医学] 10[医学] 

主　　题：Impella clinical routine 

摘      要：BACKGROUND The Impella pump has emerged as a promising tool in patients with cardiogenic shock(CS).Despite its attractive properties,there are scarce data on the specific clinical setting and the potential role of Impella devices in CS patients from routine clinical practice.METHODS This is an observational,retrospective,single center,cohort study.All consecutive patients with diagnosis of CS and undergoing support with Impella 2.5?,Impella CP?or Impella 5.0?from April 2015 to December 2020 were included.Baseline characteristics,management and outcomes were assessed according to CS severity,age and cause of CS.Main outcome measured was in-hospital mortality.RESULTS A total of 50 patients were included(median age:59.3±10 years).The most common cause of CS was acute coronary syndrome(ACS)(68%),followed by decompensation of previous cardiomyopathy(22%).A total of 13 patients(26%)had profound CS.Most patients(54%)improved pulmonary congestion at 48 h after Impella support.A total of 19 patients(38%)presented significant bleeding.In-hospital mortality was 42%.Among patients with profound CS(n=13),five patients were previously supported with venoarterial extracorporeal membrane oxygenation.A total of eight patients(61.5%)died during the admission,and no patient achieved ventricular recovery.Older patients(≥67 years,n=10)had more comorbidities and the highest mortality(70%).Among patients with ACS(n=34),35.3%of patients had profound CS;and in most cases(52.9%),Impella support was performed as a bridge to recovery.In contrast,only one patient from the decompensated cardiomyopathy group(n=11)presented with profound CS.In 90.9%of these cases,Impella support was used as a bridge to cardiac transplantation.There were no cases of death.CONCLUSIONS In this cohort of real-life CS patients,Impella devices were used in different settings,with different clinical profiles and management.Despite a significant rate of complications,mortality was acceptable and lower than those observed in other series.