Abstract
The Impella percutaneous mechanical circulatory support device is designed to augment cardiac output and reduce left ventricular wall stress and aims to improve survival in cases of cardiogenic shock. In this meta-analysis we investigated the haemodynamic effects of the Impella device in a clinical setting. We systematically searched all articles in PubMed/Medline and Embase up to July 2019. The primary outcomes were cardiac power (CP) and cardiac power index (CPI). Survival rates and other haemodynamic data were included as secondary outcomes. For the critical appraisal, we used a modified version of the U.S. Department of Health and Human Services quality assessment form. The systematic review included 12 studies with a total of 596 patients. In 258 patients the CP and/or CPI could be extracted. Our meta-analysis showed an increase of 0.39 W [95% confidence interval (CI): 0.24, 0.54], (p = 0.01) and 0.22 W/m2 (95% CI: 0.18, 0.26), (p < 0.01) for the CP and CPI, respectively. The overall survival rate was 56% (95% CI: 0.50, 0.62), (p = 0.09). The quality of the studies was moderate, mostly due to the presence of confounders. Our study suggests that in patients with cardiogenic shock, Impella support seems effective in augmenting CP(I). This study merely investigates the haemodynamic effectiveness of the Impella device and does not reflect the complete clinical impact for the patient.Electronic supplementary materialThe online version of this article (10.1007/s12471-019-01351-7) contains supplementary material, which is available to authorized users.
Highlights
The Impella (Abiomed, Danvers, MA, USA) is a percutaneous mechanical circulatory support (MCS) device consisting of a non-pulsatile microaxial flow pump based on the Archimedes screw principle that propels blood from the left ventricle into the ascending aorta
Our study suggests that in patients with cardiogenic shock, Impella support seems effective in augmenting cardiac power (CP)(I)
As CP and cardiac power index (CPI) are the best predictors for survival, we focused on the effects of Impella on CP(I)
Summary
The Impella (Abiomed, Danvers, MA, USA) is a percutaneous mechanical circulatory support (MCS) device consisting of a non-pulsatile microaxial flow pump based on the Archimedes screw principle that propels blood from the left ventricle into the ascending aorta. Aside from increasing blood flow, the Impella device aims to reduce ventricular wall stress, thereby unloading the left ventricle, reducing oxygen consumption and decreasing infarct size [1]. A series of Impella devices are available for left ventricular support. The strongest Impella, the Impella 5.0, can deliver up to 5 l/min of haemodynamic support. This includes the use of a 21 Fr pump motor, making the implantation in the acute setting more challenging [2, 3]
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