The Impella 2.5 and 5.0 devices for ST-elevation myocardial infarction patients presenting with severe and profound cardiogenic shock: The Academic Medical Center intensive care unit experience*

Objective:Cardiogenic shock remains an important therapeutic challenge, with high in-hospital mortality rates. Mechanical circulatory support may be beneficial in these patients. Since the efficacy of the intra-aortic balloon pump seems limited, new percutaneously placed mechanical left ventricular support devices, such as the Impella system, have been developed for this purpose. Our current purpose was to describe our experience with the Impella system in patients with ST-elevation myocardial infarction presenting in profound cardiogenic shock, who were admitted to our intensive care unit for mechanical ventilation. Methods:From January 2004 through August 2010, a total of 34 ST-elevation myocardial infarction patients with profound cardiogenic shock were admitted to our intensive care unit and treated with either the Impella 2.5 or the Impella 5.0 device. Baseline and follow-up characteristics were collected retrospectively. Measurements and Main Results:Within the study cohort, 25 patients initially received treatment with the Impella 2.5, whereas nine patients received immediate Impella 5.0 support. Eight out of 25 patients in the Impella 2.5 group were upgraded to 5.0 support. After 48 hrs, 14 of 25 patients in the 2.5 group were alive, five of whom had been upgraded. In the 5.0 group, eight out of nine patients were alive. After 30 days, six of 25 patients in the 2.5 group were alive, three of whom had been upgraded. In the 5.0 group, three of nine patients were alive at 30 days. Conclusions:In ST-elevation myocardial infarction patients with severe and profound cardiogenic shock, our initial experience suggests improved survival in patients who received immediate Impella 5.0 treatment, as well as in patients who were upgraded from 2.5 to 5.0 support, when compared to patients who received only Impella 2.5 support.

[1]  J. Tijssen,et al.  Long-term safety and sustained left ventricular recovery: long-term results of percutaneous left ventricular support with Impella LP2.5 in ST-elevation myocardial infarction. , 2011, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[2]  M. Acker,et al.  Use of the AB5000 ventricular assist device in cardiogenic shock after acute myocardial infarction. , 2010, The Annals of thoracic surgery.

[3]  N. Doll,et al.  Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. , 2010, The Journal of thoracic and cardiovascular surgery.

[4]  W. Paulus,et al.  Effects of mechanical left ventricular unloading by impella on left ventricular dynamics in high‐risk and primary percutaneous coronary intervention patients , 2010, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[5]  D. Wagner,et al.  Supported high-risk percutaneous coronary intervention with the Impella 2.5 device the Europella registry. , 2009, Journal of the American College of Cardiology.

[6]  J. Nordrehaug,et al.  Percutaneous left ventricular assist device can prevent acute cerebral ischaemia during ventricular fibrillation. , 2009, Resuscitation.

[7]  B. D. de Mol,et al.  A combined surgical and percutaneous approach through the axillary artery to introduce the Impella LP5.0 for short-term circulatory support. , 2009, International journal of cardiology.

[8]  Biswajit Kar,et al.  A prospective feasibility trial investigating the use of the Impella 2.5 system in patients undergoing high-risk percutaneous coronary intervention (The PROTECT I Trial): initial U.S. experience. , 2009, JACC. Cardiovascular interventions.

[9]  M. Pfisterer,et al.  Ten-Year Trends in the Incidence and Treatment of Cardiogenic Shock , 2008, Annals of Internal Medicine.

[10]  Adnan Kastrati,et al.  A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. , 2008, Journal of the American College of Cardiology.

[11]  J. Tijssen,et al.  A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? , 2008, European heart journal.

[12]  J. Tijssen,et al.  Left ventricular unloading in acute ST-segment elevation myocardial infarction patients is safe and feasible and provides acute and sustained left ventricular recovery. , 2008, Journal of the American College of Cardiology.

[13]  J. Henriques,et al.  New percutaneous mechanical left ventricular support for acute MI: the AMC MACH program , 2008, Nature Clinical Practice Cardiovascular Medicine.

[14]  D. Burkhoff,et al.  A randomized multicenter clinical study to evaluate the safety and efficacy of the TandemHeart percutaneous ventricular assist device versus conventional therapy with intraaortic balloon pumping for treatment of cardiogenic shock. , 2006, American heart journal.

[15]  N. Smedira,et al.  Improved survival after acute myocardial infarction complicated by cardiogenic shock with circulatory support and transplantation: comparing aggressive intervention with conservative treatment. , 2006, The Journal of heart and lung transplantation : the official publication of the International Society for Heart Transplantation.

[16]  J. Tijssen,et al.  Safety and feasibility of elective high-risk percutaneous coronary intervention procedures with left ventricular support of the Impella Recover LP 2.5. , 2006, The American journal of cardiology.

[17]  L. Wilkins.  ACC/AHA Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction , 2004 .

[18]  P. Herijgers,et al.  Initial experiences with the Impella device in patients with cardiogenic shock - Impella support for cardiogenic shock. , 2003, The Thoracic and cardiovascular surgeon.

[19]  E. Verbeken,et al.  Left ventricular support by catheter-mounted axial flow pump reduces infarct size. , 2003, Journal of the American College of Cardiology.

[20]  G. Schuler,et al.  Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. , 2003, European heart journal.

[21]  H. White,et al.  Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. , 1999, The New England journal of medicine.

[22]  A Kantrowitz,et al.  Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. , 1968, JAMA.

[23]  S. Werns.  A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? , 2010 .

[24]  G. Lamas,et al.  ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction--executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1999 Guidelines for the Management of Patients Wi , 2004, The Canadian journal of cardiology.