Intra-aortic Balloon Pump Versus Impella in Managing Cardiogenic Shock After Myocardial Infarction: Literature Review.

Abstract

Despite early revascularization and supportive medical therapies, acute myocardial infarction with cardiogenic shock (AMICS) remains the leading cause of death in patient's with myocardial infarction. Intra-aortic balloon pump (IABP) has been the device of choice for these patients but has failed to show mortality benefit over medical therapy alone. The Impella (AbioMed, Danvers, Massachusetts) is a more recently developed alternative in bridging patients to recovery. The aim of this study was to evaluate available evidence comparing mortality with the use of Impella (2.0 or CP) versus IABP in patients with AMICS. PubMed, CINAHL, EMBASE, and Scopus were searched to find articles comparing the outcomes of IABP versus Impella in AMICS patients. A total of 7 articles met the inclusion criteria. Thirty-day mortality was the primary outcome observed. Secondary outcomes included myocardial recovery and complications from device implantation. All studies support that there is no statistically significant reduction in mortality when utilizing the Impella over the IABP. Further research in an adequately powered randomized clinical trial is needed to shed light on the clinical characteristics of patients after AMICS who would benefit from 1 type of mechanical circulatory support over another. The therapy chosen is determined by provider discretion and skill set, as well as device availability. It is important for all care team members, including the critical care nurse, to understand the implications and complications associated with each therapy, so care can be catered to the individual patient's needs.