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Clinical Research in Cardiology

, Volume 108, Issue 11, pp 1249–1257 | Cite as

Mechanical circulatory support with Impella versus intra-aortic balloon pump or medical treatment in cardiogenic shock—a critical appraisal of current data

  • Bernhard Wernly
  • Clemens Seelmaier
  • David Leistner
  • Barbara E. Stähli
  • Ingrid Pretsch
  • Michael Lichtenauer
  • Christian Jung
  • Uta C. Hoppe
  • Ulf Landmesser
  • Holger Thiele
  • Alexander LautenEmail author
Original Paper

Abstract

Aims

Patients suffering from cardiogenic shock (CS) have a high mortality and morbidity. The Impella percutaneous left-ventricular assist device (LVAD) decreases LV preload, increases cardiac output, and improves coronary blood flow. We aimed to review and meta-analyze available data comparing Impella versus intra-aortic pump (IABP) counterpulsation or medical treatment in CS due to acute myocardial infarction or post-cardiac arrest.

Methods and results

Study-level data were analyzed. Heterogeneity was assessed using the I2 statistic. Risk rates were calculated and obtained using a random-effects model (DerSimonian and Laird). Four studies were found suitable for the final analysis, including 588 patients. Primary endpoint was short-term mortality (in-hospital or 30-day mortality).

In a meta-analysis of four studies comparing Impella versus control, Impella was not associated with improved short-term mortality (in-hospital or 30-day mortality; RR 0.84; 95% CI 0.57–1.24; p = 0.38; I2 55%). Stroke risk was not increased (RR 1.00; 95% CI 0.36–2.81; p = 1.00; I22 0%), but risk for major bleeding (RR 3.11 95% CI 1.50–6.44; p = 0.002; I2 0%) and peripheral ischemia complications (RR 2.58; 95% CI 1.24–5.34; p = 0.01; I2 0%) were increased in the Impella group.

Conclusion

In patients suffering from severe CS due to AMI, the use of Impella is not associated with improved short-time survival but with higher complications rates compared to IABP and medical treatment. Better patient selection avoiding Impella implantation in futile situations or in possible lower risk CS might be necessary to elucidate possible advantages of Impella in future studies.

Keywords

Impella IABP Mechanical support system Cardiogenic shock Emergency treatment 

Notes

Funding

No (industry) sponsorship has been received for this study.

Compliance with ethical standards

Conflict of interest

The authors report no relationships that could be construed as a conflict of interest.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Bernhard Wernly
    • 1
  • Clemens Seelmaier
    • 1
  • David Leistner
    • 2
    • 3
    • 4
  • Barbara E. Stähli
    • 5
  • Ingrid Pretsch
    • 1
  • Michael Lichtenauer
    • 1
  • Christian Jung
    • 6
  • Uta C. Hoppe
    • 1
  • Ulf Landmesser
    • 2
    • 3
    • 4
  • Holger Thiele
    • 7
  • Alexander Lauten
    • 2
    • 3
    Email author
  1. 1.Clinic of Internal Medicine II, Department of CardiologyParacelsus Medical University of SalzburgSalzburgAustria
  2. 2.Department of CardiologyCharité—Universitaetsmedizin BerlinBerlinGermany
  3. 3.Deutsches Zentrum für Herz-Kreislaufforschung (DZHK)—Partner Site BerlinBerlinGermany
  4. 4.Berlin Institute of Health (BIH)BerlinGermany
  5. 5.Department of CardiologyUniversitaetsspital ZuerichZuerichSwitzerland
  6. 6.Division of Cardiology, Pulmonology, and Vascular Medicine, Medical FacultyUniversity DuesseldorfDuesseldorfGermany
  7. 7.Department of Internal Medicine/CardiologyHeart Center Leipzig at University of LeipzigLeipzigGermany

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