Multicenter Impella Experience Data from Dr. Andreas Schäfer
Impella for AMI Cardiogenic Shock
Dr. Andreas Schäfer, an interventional cardiologist and intensivist from Hannover, Germany, discusses data from an abstract he presented at the American College of Cardiology regarding use of Impella® in patients with acute AMI cardiogenic shock.
Dr. Schäfer describes data from 166 patients from 4 centers in Germany and Denmark. Patients fulfilled all SHOCK II inclusion criteria. His analysis used predictive models of cardiogenic shock risk scores using the IABP-SHOCK II trial risk scores and CardShock risk scores. Both of these scores divide risk into low, intermediate, and high predicted risk of mortality, with high risk being about 70% mortality for in-hospital patients. Dr. Schafer explains that using Impella in patients predicted to be at high risk of mortality led to dramatic reductions in mortality. “So, it looks like the sickest patients are the ones that might profit from this strategy.”
Dr. Schäfer also notes 2 other very strong predictors of improved outcomes in these patients. The first has to do with the timing of Impella insertion. Inserting Impella prior to PCI in these patients resulted in a much lower mortality rate. In addition, higher mortality was seen in patients who had been resuscitated before arrival at the hospital.
Dr. Schäfer brings a unique perspective as both an interventional cardiologist and an intensivist. He highlights that all centers in this study had cardiogenic shock algorithms for recognizing shock early in the ER and that all shock and resuscitated patients were transferred to the cath lab prior to admission to the ICU for proper workup, including visualization of the coronary arteries. Dr. Schäfer emphasizes that the key to treating a patient in cardiogenic shock is “to stabilize the patient very early.”
Dr. Schäfer also describes that the average duration of Impella support was about 1 week. He notes, “It is important not to be too eager to get the Impella out if the patient is unstable.” He explains that he’s had good experience supporting patients without leg ischemia and without many patients requiring escalation of support to therapies such as the combination of Impella and EMCO.
- Improving Survival in Cardiogenic Shock by Adopting a Uniform Approach to Systems of Care
- Case Review Video: AMI Cardiogenic Shock
- Best Practice Protocols for Improving Cardiogenic Shock Outcomes
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: www.protectedpci.com/indications-use-safety-information/