Maximum level of mobility with axillary deployment of the Impella 5.0 is associated with improved survival.

Abstract

Mobility is an important prognostic indicator for patients with cardiogenic shock. No studies have quantified peak mobility for patients with cardiogenic shock who are supported with the Impella 5.0 acute mechanical circulatory support device. The purpose of our study was to evaluate mobility levels among patients with cardiogenic shock being treated with an axillary Impella 5.0 pump. We retrospectively analyzed data from 19 patients receiving an Impella 5.0 device for cardiogenic shock at our institution from 2013 to 2016. We used the Johns Hopkins Highest Level of Mobility Scale to quantify maximum mobility level achieved during active Impella 5.0 support. Higher scores on a scale of 1-8 indicated more mobility. Activity Measure for Post Acute Care Scores were quantified for each patient to assess activity limitations, with a maximum score 24. The mean age of the total cohort was 60 ± 12 years, and the mean left ventricular ejection fraction was 16% ± 6%. In-hospital mortality was 47% (n = 9). Of the 19 Impella 5.0 implants, 10 survived, 6 died from withdrawal of care, and 3 died from worsening heart failure/cardiogenic shock. Similar rates of mobilization during the time of Impella implant were seen between groups. Compared to non-survivors, survivors achieved a higher maximum Johns Hopkins Highest Level of Mobility level, but similar Activity Measure for Post Acute Care scores. In conclusion, maximum mobility after Impella 5.0 implantation may be associated with improved survival. The clinical utility of exercise as a therapeutic intervention for patients requiring prolonged acute mechanical circulatory support requires further study.