Author + information
- Murad Abdelsalam1,
- Augustine George2,
- Brett Milford1,
- Rudin Gjeka1,
- Nishtha Sareen3,
- Abdul Halabi4,
- Michele De Gregorio5 and
- Kiritkumar Patel6
- 1Saint Joseph Mercy Oakland, Pontiac, Michigan, United States
- 2Saint Joseph Mercy Oakland, Auburn Hills, Michigan, United States
- 3St Joseph Mercy Oakland Hospital, Birmingham, Michigan, United States
- 4Saint Joseph Mercy Oakland, Bloomfield Hills, Michigan, United States
- 5Saint Joseph Mercy Oakland, bloomfield hills, Michigan, United States
- 6Saint Joseph Mercy Oakland, Bloomfield hills, Michigan, United States
Acute myocardial infarction complicated by cardiogenic shock (AMICS) is associated with high mortality rates. Use of Impella device (Abiomed, Inc., Danvers, MA, USA), a microaxial left ventricular assist device, has been approved for cardiogenic shock. We aim to evaluate feasibility and short-term results of this device in community hospital settings.
A retrospective chart review of 18 patients who underwent left ventricle unloading with the Impella CP device through femoral artery for AMICS was performed from June 1, 2016 to June 1 2017. Data were evaluated with regard to baseline and procedural characteristics and also included an assessment of the short term clinical outcomes.
A total of 18 patients (13 men), mean age (66.7 ± 14.16 years) with AMICS. Majority of patients had STEMI (83%), and more than half with cardiac arrest (56%). All patients received Impella device during the initial coronary intervention. Pre-PCI placement was performed in 9 patients (50%), 6 patients (33%) had intra-procedural placement and the reminder (17%) had Post -PCI placement. For patients with STEMI presentation, door to balloon and door to unload times were 61 minutes and 69 minutes respectively. Shock onset to device time for all patients was 64 mins. The infarct related artery was LAD in 43%, RCA in 28%, LCx in 19% and LM in 10% of patients. Complete revascularization was achieved in 78 % of patients. The mean duration of Impella was 49 hours and average ICU stay was 5 days. One patient was transferred for ECMO support, one patient had ischemic stroke. Another patient had hemolysis requiring device explanation, and two patients had limb ischemia requiring external femoral bypass during the same intervention. Survival rate to discharge was 61%.
Left ventricular unloading with the use of Impella CP device in AMICS is feasible and provides beneficial hemodynamic support. Survival to discharge was better than historic data in these critically ill patients.
CORONARY: Hemodynamic Support and Cardiogenic Shock