Introducing Impella, a support for survival in critical cardiac situations

Acute heart failure and multivessel coronary artery stenosis leading to heart failure due to severe weakening of the heart muscles are among the most common and significant health problems. Treatment requires specialized medical expertise and the use of cutting-edge technology to increase survival and reduce potential complications, especially in high-risk patients.

Currently, there are two types of cardiac support devices commonly used in Thailand: the intra-aortic balloon pump (IABP) and, in critical cases, the extracorporeal membrane oxygenation (ECMO). However, a new device is now available that could save lives: Impella, a tiny heart pump approved by the U.S. Food and Drug Administration (FDA) for its effectiveness and safety.

 

What is Impella?

Impella is a percutaneous microaxial flow pump. It is a tiny blood pumping device inserted via catheter through an artery in the groin or arm. With its tip positioned in the left ventricle, the device pumps blood into the aorta. It can pump up to 4.3 liters of blood per minute, equivalent to the amount that a normal human heart can pump, approximately 3-5 liters per minute. Studies have shown that Impella improves the heart's blood supply to the body and reduces the risk of death from cardiogenic shock. The mortality rate at 180 days is reduced by as much as 26%¹.


 

In what situations is Impella used?

The Impella heart pump is used in the following three main situations:

• Cardiogenic Shock in Acute Myocardial Infarction - The Impella heart pump reduces the pressure and the volume in the left ventricle and improves blood flow in patients experiencing cardiogenic shock. During emergency coronary angioplasty, the Impella device is inserted and kept there until the patient recovers or for a short period of time, no more than 7 days¹.
• Complex High-Risk Indicated PCI (CHIP-PCI) -For patients with systolic heart failure, pulmonary edema, and multivessel coronary artery stenosis. they are at high risk of complications during the angioplasty including insufficient blood supply to the heart and cardiogenic shock. The Impella implantation will help stabilize the heart and prevent complications. Once the procedure is complete and the patient recovers without complications, the device is removed^2,3,4.
• Combined use of Impella and ECMO (ECMELLA) - In patients with severe conditions requiring ECMO to support the heart and lungs, the absence of heart contraction and the sole reliance on ECMO may lead to blood sedimentation and, in turn, blood clots within the heart chambers, increasing blood pressure as well as the heart's workload. Using the Impella in conjunction with ECMO helps pump blood out of the heart into the aorta, reducing the risk of blood clots and reducing the heart's workload while waiting for recovery⁵.

 
 

Possible Complications with Impella Use

Despite the significant benefits of Impella, there are risks of potential complications, including:

• Bleeding in the groin, where Impella is inserted via the catheter
• Infection
• Kidney failure

These risks can be minimized if the procedure is performed by a specialist experienced in Impella implantation.

At the Heart Institute, Bumrungrad International Hospital, our cardiologists are trained and experienced in using Impella as a life-saving device for critically ill patients, both in emergencies and when detailed treatment plans are required. Integrating our medical team's expertise with cutting-edge technology allows us to handle complex cases quickly and efficiently, ensuring patients receive the safest and most appropriate treatment. This not only increases the chance of recovery but also helps restore a normal quality of life.

 


Rerfence:

1. Møller JE, Engstrøm T, Jensen LO, Eiskjær H, Mangner N, Polzin A, Schulze PC, Skurk C, Nordbeck P, Clemmensen P, Panoulas V, Zimmer S, Schäfer A, Werner N, Frydland M, Holmvang L, Kjærgaard J, Sørensen R, Lønborg J, Lindholm MG, Udesen NLJ, Junker A, Schmidt H, Terkelsen CJ, Christensen S, Christiansen EH, Linke A, Woitek FJ, Westenfeld R, Möbius-Winkler S, Wachtell K, Ravn HB, Lassen JF, Boesgaard S, Gerke O, Hassager C; DanGer Shock Investigators. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med. 2024 Apr 18;390(15):1382-1393. doi: 10.1056/NEJMoa2312572
2. Ferro EG, Kim JM, Lalani C, Abbott DJ, Yeh RW. Mechanical circulatory support for complex, high-risk percutaneous coronary intervention. EuroIntervention. 2025 Feb 3;21(3):e149-e160. doi: 10.4244/EIJ-D-24-00386.
3. Impella-Supported PCI in High-Risk Patients With Complex Coronary Artery Disease and Reduced Left Ventricular Function (PROTECT IV). ClinicalTrials.gov Identifier: NCT04763200. Available at: https://classic. clinicaltrials.gov/ct2/show/NCT04763200
4. Controlled Trial of High-risk Coronary Intervention With Percutaneous Left Ventricular Unloading (CHIP-BCIS3). ClinicalTrials.gov Identifier: NCT05003817. Available at: https://classic.clinicaltrials.gov/ct2/show/NCT05003817
5. Nersesian G, Potapov E. Mechanical circulatory support with ECMELLA approach in severe cardiogenic shock patients-state of the art. J Thorac Dis. 2023 Sep 28;15(9):4555-4557. doi: 10.21037/jtd-2023-08.

 

By Pol.Capt.Dr. Sakolwat Montrivade