Impella 2.5™ and VA-ECMO Provide Hemodynamic Improvement in Patients with Cardiogenic Shock
Standard treatment of cardiogenic shock often includes the initiation of revascularization and the use of vasoconstrictors, inotropes, and the intra-aortic balloon pump. When cardiogenic shock resists traditional therapy, it can present a clinical challenge in addition to a substantially high mortality rate. Despite the advances in medicine and technology, cardiogenic shock maintains a mortality rate of a little less than 50%.1
Current options for refractory cardiogenic shock have grown to include not only the armamentarium of standard cardiogenic shock therapies, but also percutaneous mechanical circulatory support (MCS) devices like the Impella 2.5™. Additionally, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is often considered for patients with refractory cardiogenic shock, sometimes in combination with MCS devices, to help improve hemodynamic support.
A study from the November issue of the International Journal of Cardiology retrospectively examined in-hospital mortality for refractory cardiogenic shock patients receiving biventricular support from Impella 2.5™ and VA-ECMO. In about 71% of patients, the Impella 2.5™ was initiated before VA-ECMO.2
The center reporting biventricular support in this study notes that Impella 2.5™ is implanted first for cardiogenic shock caused by isolated left ventricular failure, whereas VA-ECMO is generally the first choice in the event of left ventricular failure and persistent cardiac arrest or pulmonary failure.
For the purpose of this study, refractory cardiogenic shock was defined by the following:
- Continual impaired end-organ perfusion despite aggressive medical therapy
- Persistent hypotension (systolic blood pressure less than 90 mmHg)
The use of inotropes and vasoconstrictors was significantly reduced 72 hours after biventricular support. Serum lactate, a prominent marker associated with cardiogenic shock, also decreased within the same time period for patients receiving concomitant therapy (Figure 1).
Figure 1 - Serum lactate levels of patients on biventricular supporta
Roughly half (44%) of treated patients with refractory cardiogenic shock received the dual treatment that allowed for ICU discharge to bridging to a long-term ventricular assist device or cardiac rehabilitation. The 28-day survival was 41%, however, possibly contributable to the critically ill patient selection for this study.
- Babaev A, Frederick PD, Pasta DJ, et al. Trends in management and outcomes of patients with acute myocardial infarction complicated by cardiogenic shock. JAMA. 2005;294(4):448-454.
- Karatolios K, Chatzis G, Markus B, et al. Biventricular unloading in patients with refractory cardiogenic shock. Int J Cardiol. 2016;222:247-252.
To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: abiomed.com/important-safety-information