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Use of Impella cardiac axial flow pump for cardiogenic shock(A newer alternative)-How good is the evidence?

BIOCELL 2022年第5期46卷 1139-1150页

作者： RAFIQ AHMED BHAT SYED MANZOOR ali yoosuf ali ashraf muhammad hussenbocus AKANKSHA RATHI JAVAID AKHTER BHAT ABDUL ALEEM KHAN SYED MAQBOOL RAJA SAQIB IQBAL MD MONOWARUL ISLAM YONGSHENG QU YOU ZHANG YUXIAO SUN WENTAO XIAO ABHISHEK TIBREWAL CHUANYU GAO Zhengzhou University People’s Hospital Department of CardiologyFuwai Central China Cardiovascular HospitalZhengzhouChina2 Department of CardiologySuper Speciality DivisionGovernment Medical CollegeSrinagarIndia3 Department of Rheumatology and ImmunologyNanjing Drum Tower Hospital Clinical College of Nanjing Medical UniversityNanjingChina4 Department of Community MedicineVedanta Institute of Medical SciencesPalgharIndia5 State Key Laboratory of Crop Genetics and Germplasm EnhancementNanjing Agricultural UniversityNanjingChina6 Department of OrthopaedicsNanjing First HospitalNanjing Medical UniversityNanjingChina7 Department of PaediatricsBatra Hospital and Medical Research CentreNew DelhiIndia8 Zhengzhou University First Affiliated HospitalZhengzhouChina9 Department of Community MedicineInstitute of Biostatistics and EpidemiologyGurgaonIndia

The adverse outcomes of a ventricular heart failure(left,right or biventricular)caused by cardiogenic shock are aggravated by lung oedema and organ mal perfusion.Despite advances in medical sciences,revascularisation and mechanical hemodynamic support have proved ineffective in reducing the mortality rate in such patients.A thorough study of the data available about cardio-vascular diseases reveals that the application of conventional methods of treatment are least helpful to practically restore normal functions of heart when it experiences end-stage systolic ventricular failure.Thus,to overcome the challenges and find alternatives to address this issue,percutaneous ventricular support devices/machines were designed and successfully introduced.These devices have revolutionized the treatment of ventricular heart failures and are now in use all over the world.In this review paper a newer mechanical circulatory support(MCS)device,Impella,has been discussed and compared with a few other devices like(Intra-aortic Balloon Pump(IABP),Extracorporeal Circulation(ECLS)and Veno-arterial Extracorporeal Membrane Oxygenation(VA-ECMO).This article studies the challenges being faced during the treatment of cardiogenic shock,and thoroughly discusses the use and effectiveness of Impella Cardiac Axial Pump in each emergency.It can be said that mechanical circulatory support(MCS)device use during percutaneous coronary intervention(PCI)should be individualized based on multiple factors with a recommended use in patients with the greatest potential benefit and a relatively low risk of device-related complications.The current literature suggests that the outcomes of use of Impella and other mechanical circulatory support devices like IABP and VA-ECMO are comparable.Though there seem to be a few advantages of Impella over the others,sufficiently powered,multi-centric,randomised control trials are needed to establish its superiority.

关键词： Cardiogenic shock Hemodynamic support Impella Cardiac Axial Pump IABP VA-ECMO

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