Outcomes Of Refractory Cardiogenic Shock Patients Supported By Impella 5.5: Single Center Experience

Background Cardiogenic shock (CS) is often associated with a high risk of morbidity and mortality, and short-term mechanical circulatory support (MCS) can be a life-saving treatment. In this report, we describe our experience with the percutaneous left ventricular assist devices (Impella 5.5) to support cardiogenic shock patients as a bridge to recovery or advanced heart failure (HF) therapies. Methods We retrospectively reviewed electronic medical records of 36 CS patients supported by Impella 5.5 at our institution from May 2020 to December 2021. Baseline patient characteristics, pre-implant laboratory values, duration of support, ICU and hospital length of stay (LOS) were evaluated. Outcomes including weaning of Impella 5.5, survival to discharge, morbidity and mortality were collected. Results A total of 36 patients were included in this study (Table 1). The mean age was 57 years ± 12, and 72% were male. The etiology of cardiogenic shock included non-ischemic cardiomyopathy in 12 (33%) patients, ischemic cardiomyopathy in 7 (19%), mixed in 1 (3%), acute myocardial infarction in 8 (22%), post-cardiotomy shock in 5 (14%), and myocarditis in 3 (8%). The Mean duration of support was 21 days ± 24 (median=12.5 days; 2-138), with a mean Hospital LOS of 40 days ± 30 (3-152) and mean ICU days of 33 days ± 26 (3-144). Of the 36 patients, 15 (42%) were transitioned to advanced HF therapies (LVAD=9 (25%), HTx=6 (17%)). Nine (25%) patients showed signs of myocardial recovery and were weaned, 2 patients were transferred to an outside hospital for double organ transplant, while care was withdrawn on 10 (28%) patients. Twenty-five (69%) patients survived to discharge. In 12 (33%) patients, Impella 5.5 was used as an additional tool to unload the left ventricle while on VA-ECMO. Bleeding not related to the pump (n=8, 22%) was the most common complication observed, followed by 2 (6%) cases of stroke (n=2, 6%), and one each of hemolysis (3%) and pump thrombosis (3%). Ten (28%) patients experienced pump malposition, which required adjustment under echo guidance. Conclusion Our initial short-term results demonstrate that Impella 5.5 is a reliable temporary MCS with low complication profile, with excellent survival to recovery or destination therapies. Multi-center trials are still required to validate the outcomes. Cardiogenic shock (CS) is often associated with a high risk of morbidity and mortality, and short-term mechanical circulatory support (MCS) can be a life-saving treatment. In this report, we describe our experience with the percutaneous left ventricular assist devices (Impella 5.5) to support cardiogenic shock patients as a bridge to recovery or advanced heart failure (HF) therapies. We retrospectively reviewed electronic medical records of 36 CS patients supported by Impella 5.5 at our institution from May 2020 to December 2021. Baseline patient characteristics, pre-implant laboratory values, duration of support, ICU and hospital length of stay (LOS) were evaluated. Outcomes including weaning of Impella 5.5, survival to discharge, morbidity and mortality were collected. A total of 36 patients were included in this study (Table 1). The mean age was 57 years ± 12, and 72% were male. The etiology of cardiogenic shock included non-ischemic cardiomyopathy in 12 (33%) patients, ischemic cardiomyopathy in 7 (19%), mixed in 1 (3%), acute myocardial infarction in 8 (22%), post-cardiotomy shock in 5 (14%), and myocarditis in 3 (8%). The Mean duration of support was 21 days ± 24 (median=12.5 days; 2-138), with a mean Hospital LOS of 40 days ± 30 (3-152) and mean ICU days of 33 days ± 26 (3-144). Of the 36 patients, 15 (42%) were transitioned to advanced HF therapies (LVAD=9 (25%), HTx=6 (17%)). Nine (25%) patients showed signs of myocardial recovery and were weaned, 2 patients were transferred to an outside hospital for double organ transplant, while care was withdrawn on 10 (28%) patients. Twenty-five (69%) patients survived to discharge. In 12 (33%) patients, Impella 5.5 was used as an additional tool to unload the left ventricle while on VA-ECMO. Bleeding not related to the pump (n=8, 22%) was the most common complication observed, followed by 2 (6%) cases of stroke (n=2, 6%), and one each of hemolysis (3%) and pump thrombosis (3%). Ten (28%) patients experienced pump malposition, which required adjustment under echo guidance. Our initial short-term results demonstrate that Impella 5.5 is a reliable temporary MCS with low complication profile, with excellent survival to recovery or destination therapies. Multi-center trials are still required to validate the outcomes.