Panoulas Paper on Impella Experience in the UK
Impella® Support: Clinical Utility, Indications, and Outcomes
Vasileios Panoulas, MD, PhD, MRCP, FESC is the senior author of a paper that adds Impella experience in London, UK to the world’s Impella literature. His paper, recently published in Cardiovascular Revascularization Medicine, is titled “Clinical Indications of IMPELLA Short-Term Mechanical Circulatory Support in a Tertiary Centre.” Dr. Panoulas is an interventional cardiologist with the Royal Brompton & Harefield NHS Foundation Trust in London, UK and a senior lecturer at the Imperial College of London.
Dr. Panoulas explains that Impella use has been gaining momentum in the UK in the past few years, particularly for cardiogenic shock, and he and his colleagues undertook this study to assess the clinical utility, indications, and outcomes of the Impella family of devices in their tertiary center. In particular, they examined outcomes based on the patient’s SCAI shock classification (Stage A-E).
In this paper, the majority of patients treated with left-sided mechanical circulatory support (MCS)—Impella CP® and Impella 5.0®—had cardiogenic shock secondary to acute coronary syndrome (ACS), decompensated dilated or ischemic end stage cardiomyopathy, or myocarditis. Patients were treated with Impella RP® for right ventricular failure following LVAD implantation or post-transplant.
Dr. Panoulas describes significant reductions in lactate levels and inotropic support requirements from pre-Impella to 24 hours post-Impella implantation, as well as improvements in creatinine and liver enzymes in response to Impella support within 24 hours. “So this, to us,” he states, “indicates that the device improves the cardiac output and systemic perfusion.”
Dr. Panoulas also describes outcomes by device type, highlighting that about one-third of the patients receiving Impella CP support recovered native heart function and about 40% of Impella RP patients recovered right heart function. Fewer Impella 5.0 patients recovered native heart function, likely due to the device being used in patients with more severe acute and chronic decompensated heart failure.
Dr. Panoulas discusses the importance of shock coming in “different flavors” with expectations for survival decreasing at deeper levels of shock (Stages D and E). He notes that physicians can get discouraged if they only use Impella for the deepest levels of shock. “I would recommend, at least from our experience, that the Impella device has to be started to be used in less deeply shocked patients, and probably more stable patients initially, and then moving on to the more deep shock, which are always challenging to manage.”
Dr. Panoulas emphasizes the importance of creating shock protocols and a shock team. He explains that at his center they have developed a shock protocol that can rapidly classify shock and allow the team to implement an MCS strategy according to SCAI shock stage. They are also defining a protocol for patient follow-up in the ICU that monitors for complications and, based on parameters such as CPO, determines whether the patient is recovering or requires escalation.
“I think the most important message is, for us, from this paper,” Dr. Panoulas concludes, “we explored the indications of the device, we understood that the device is very powerful, and it will do its job but, then it comes down to the clinicians to identify when and how to use it appropriately, for which patients.”
- SCAI Shock Classification Helps Predict Survival
- Shock Team Protocols with Dr. Truesdell and Dr. Tehrani
- Implementing Cardiogenic Shock Protocols
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