Original title: The Use of Impella 2.5 in Severe Refractory Cardiogenic Shock Complicating and Acute Myocardial Infarction. Reference: Frederic Casassus et al. J Interv Cardiol. 2015 Feb;28(1):41-50.
The presence of cardiogenic shock is observed in 7% of patients undergoing acute myocardial infarction (AMI) with ST segment elevation and 2.5% of those with non-ST AMI. In this scenario inotropic have a poor response and the intra-aortic balloon pump (IABP) has been shown in multiple trials to be little or no effective.
22 patients who received the Impella 2.5 device and about to undergoing AMI with refractory cardiogenic shock were analyzed. Angioplasty was performed to culprit vessel and other vessels were treated in accordance with the decision of the surgeon. The involvement of other organs with SOFA and APACHE scores were analyzed prior to implantation of the device.
The average age of the population was 58 years and 40% had cardiopulmonary arrest prior to admission. The SOFA and APACHE scores were 9 and 30 points. All received inotropic; shock start mean time was 7 hours (1.8-19), IABP 54.6%. Angioplasty was successful in 86.4%. Half had cerebral anoxia injury, respiratory failure, and pulmonary edema. The third group showed severe acute deterioration of kidney function (eGFR <30). The Impella device was implanted using femoral approach successfully in all patients. There was a significant immediate improvement of ventricular filling pressures and ventricular function (27 ± 9% versus 43 ± 10%; p <0.0001). Peripheral perfusion improved after 48 hours of support. Impella 2.5 average time was 35.5 hours (21.5-57.8 hours).
Survival at 6 and 12 months was 59.1% and 54.5%. There was no stroke or vascular complications requiring surgery.
Conclusion
The Impella 2.5 was used as a last alternative in patients who had cardiogenic shock and not responding to conventional treatment. The use of the device was favorable to short and medium term survival.
Editorial comment
This work covered a small population with a high mortality. Inotropic and IABP demonstrated its limited effectiveness. Ventricular assist devices are proving their benefit, giving an improvement in ventricular function, systemic injury and improving survival in the middle term with a low rate of complications related to the device. The development of these devices will help in this scenario.
Courtesy of Carlos Fava MD
Interventional Cardiologist
Buenos Aires – Favaloro Foundation
Carlos Fava