Authors (including presenting author) :
Lau KY(1), Leung AMS(1), Ma TSK(1), Lau FM(1), Tai PWH(1), Lai PCK(1), Chan WK(1), Ngo OL(1), Ngai CW(1)
Affiliation :
(1)Department of Adult Intensive Care Unit, Queen Mary Hospital
Introduction :
Cardiogenic shock is a life-threatening condition due to impaired cardiac function. Impella is a percutaneous, micro-axial ventricular assist device capable of providing a form of temporary mechanical circulatory support (MCS) to the failing heart and improving end-organ perfusion.
Objectives :
This project aims to analyze the outcomes of patients with cardiogenic shock treated with the Impella in a local adult intensive care unit (ICU).
Methodology :
A retrospective review on the Impella service in an ICU was conducted. Patient demographics, the causes of cardiogenic shock, therapy characteristics and clinical outcomes were collected for analysis.
Result & Outcome :
A total of 37 patients were identified from January 2020 to November 2024. The mean age of the patients was 57.2±12.5 years, with 81.1% male. The most common underlying causes of cardiogenic shock were acute myocardial infarction (70.3%) and acute myocarditis (10.8%). 27.5% of patients required an upgrade in MCS from Impella to veno-arterial extracorporeal membrane oxygenation (VA-ECMO) due to conditions refractory to the initial therapeutics. 17.5% of patients needed Impella support for left ventricle unloading after VA-ECMO establishment. Mean duration of Impella use was 4.5 ± 3.6 days, and the rate of survival to explant was 80%. Mean ICU length of stay was 9.4±11.9 days. 30-day mortality rate was 34.4%. For patients on Impella support for more than 24 hours, mean lactate levels decreased from 4.6±4.3 mmol/L at baseline to 2.7±2.7 mmol/L after 24 hours of support, indicating improvement in end-organ perfusion. Device-related complications included limb ischemia (2.5%), major bleeding (2.5%) and hemolysis (15%). The rates of limb ischemia and major bleeding in the ICU under evaluation were lower than those reported in the literature whereas the hemolysis rate was comparable to the literature findings. Impella is proven to be an effective and safe method in providing circulatory support for patients with cardiogenic shock in the adult ICU setting
