Abstract Body (Do not enter title and authors here): Background: Despite widespread use of the Impella 5.5 to support patients with cardiogenic shock (CS), the identification of patient profiles that benefit the most from this intervention remains a challenge. Understanding the clinical and hemodynamic characteristics associated with successful outcomes is crucial for optimizing patient selection and management.
Methods: Using data from a comprehensive registry of 508 patients, we evaluated clinical stabilization among those receiving Impella 5.5 for CS. Clinical stabilization was defined as weaning from the Impella 5.5 without escalation to additional mechanical circulatory support and discharge from the hospital alive, or bridging to durable heart replacement therapy (HT or LVAD) without further escalation of support.
Results: Of the 508 patients analyzed, 30.7%(N=156) achieved clinical stabilization. The mean age of the cohort was 58.4±12.6 years, with 83.7% being male. Heart failure-related cardiogenic shock (HF-CS) was present in 69.5% of the patients. No significant demographic differences were observed between the stabilization and deterioration groups (p>0.05). Patients who stabilized were more likely to have HF-CS (p<0.001) and lower incidence of out-of-hospital cardiac arrest (OHCA)(p<0.001). Higher pulmonary artery pressure (mPAP, p=0.02) and pulmonary capillary wedge pressure (PCWP, p<0.001) were significant predictors of stabilization. The presence of implantable cardioverter-defibrillators (ICDs) was more common in stabilized patients (p=0.01). Major complications such as stroke (stabilization:3.8%, deterioration:6.1%, p=0.3), limb ischemia (stabilization:1.9%, deterioration:7.4%, p=0.02), and bleeding requiring surgery (stabilization:7.7%, deterioration:12.8%, p=0.09) were observed. Notably, bleeding requiring transfusion was significantly higher in the deterioration group (41.5% vs. 30.1%,p=0.02). The median duration from Impella 5.5 insertion to heart recovery or discharge was 15.1 days (IQR:7.7-29.1 days).
Conclusions: Among patients with CS supported with the Impella 5.5, those with HF-CS, higher pulmonary pressures, and the presence of ICDs are more likely to achieve clinical stabilization. Significant complications, including bleeding and limb ischemia, remain a concern and require careful management. This study highlights the importance of detailed pre-implant hemodynamic assessment and suggests that targeted management strategies based on these predictors could improve patient outcomes.