What are the indications for Impella (intra-aortic balloon pump)?

From the Guidelines

The Impella device is primarily indicated for patients with severe left ventricular dysfunction requiring temporary mechanical circulatory support, particularly in cardiogenic shock following acute myocardial infarction, fulminant myocarditis, or end-stage heart failure, as well as for high-risk percutaneous coronary interventions (PCI) in patients with severe coronary artery disease and reduced left ventricular function. The Impella device is used to provide temporary mechanical circulatory support in various clinical scenarios, including:

• Cardiogenic shock following acute myocardial infarction, fulminant myocarditis, or end-stage heart failure as a bridge to recovery, transplantation, or longer-term support devices 1
• High-risk percutaneous coronary interventions (PCI) in patients with severe coronary artery disease and reduced left ventricular function, where hemodynamic support may prevent hemodynamic collapse during the procedure 1
• Post-cardiotomy cardiogenic shock when patients fail to wean from cardiopulmonary bypass after cardiac surgery The device works by unloading the left ventricle and augmenting cardiac output, improving end-organ perfusion while reducing myocardial oxygen demand and workload. Different Impella models provide varying levels of support, from 2.5 L/min to 5.0 L/min, with selection based on the degree of support needed and patient anatomy. Contraindications include severe aortic valve disease, mechanical aortic valve, ventricular septal defect, left ventricular thrombus, and severe peripheral arterial disease limiting vascular access. According to the most recent evidence, the use of Impella devices has been associated with improved outcomes in patients with cardiogenic shock, although the results are not uniform across all studies 1.

Key considerations for the use of Impella devices include:

• Patient selection: Impella devices are most beneficial for patients with severe left ventricular dysfunction and cardiogenic shock 1
• Timing of device insertion: Early insertion of the Impella device may be associated with improved outcomes 1
• Device selection: The choice of Impella device depends on the degree of support needed and patient anatomy 1
• Monitoring and management: Close monitoring and management of patients with Impella devices are crucial to minimize complications and optimize outcomes 1

From the Research

Indications for Impella

The Impella device has several indications, including:

• Emergency use for cardiogenic shock 2
• Non-emergent use during high-risk percutaneous coronary intervention (HR-PCI) 2, 3
• Ventricular tachycardia ablation 2
• Bridge to recovery, durable device, heart transplantation, and heart surgery for cardiogenic shock 2
• Prophylactic use in high-risk patients undergoing open heart surgery to prevent postcardiotomy cardiogenic shock 2
• Hemodynamic support in patients with severe aortic stenosis, particularly those with left ventricular failure and cardiogenic shock 4
• Acute coronary syndrome complicated by cardiogenic shock 5
• High-risk PCI and/or balloon aortic valvuloplasty in patients with severe aortic stenosis 4
• Hemodynamic collapse during transcatheter aortic valve replacement (TAVR) 4

Clinical Scenarios

Impella may be beneficial in various clinical scenarios, including:

• Cardiogenic shock due to acute myocardial infarction 3, 5
• High-risk PCI with multivessel disease 3
• Severe left ventricular dysfunction and coronary artery disease (CAD) requiring high-risk PCI and/or balloon aortic valvuloplasty 4
• TAVR with hemodynamic collapse 4