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Review
. 2021 Mar 9;77(9):1243-1256.
doi: 10.1016/j.jacc.2020.12.054.

Managing Patients With Short-Term Mechanical Circulatory Support: JACC Review Topic of the Week

Tim Balthazar  1 , Christophe Vandenbriele  2 , Frederik H Verbrugge  3 , Corstiaan Den Uil  4 , Annemarie Engström  4 , Stefan Janssens  5 , Steffen Rex  6 , Bart Meyns  7 , Nicolas Van Mieghem  8 , Susanna Price  9 , Tom Adriaenssens  5
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Free article
Review

Managing Patients With Short-Term Mechanical Circulatory Support: JACC Review Topic of the Week

Tim Balthazar et al. J Am Coll Cardiol. .
Free article

Abstract

The use of mechanical circulatory support for patients presenting with cardiogenic shock is rapidly increasing. Currently, there is only limited and conflicting evidence available regarding the role of the Impella (a microaxial, continuous-flow, short-term, left or right ventricular assist device) in cardiogenic shock; further randomized trials are needed. Patient selection, timing of implantation, and post-implantation management in the cardiac intensive care unit are crucial elements for success. Particular challenges at the bedside include the practical management of anticoagulation, evaluation of correct device position, and the approach to use in a patient with signs of insufficient hemodynamic support. Profound knowledge of these issues is required to enable the maximal potential of the device. This review provides a comprehensive overview of the short-term assist device and describes a practical approach to optimize care for patients supported with the device.

Keywords: Impella; acute heart failure; anticoagulation; cardiac intensive care; cardiogenic shock; hemodynamics.

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Conflict of interest statement

Funding Support and Author Disclosures Drs. Balthazar, Vandenbriele, Engström, Meyns, Van Mieghem, and Price have reported receiving research and/or travel funding, as well as speaker fees, from Abiomed. Dr. Balthazar was supported by a grant from the Van De Werf fund for clinical research. Dr. Vandenbriele has reported being supported by a grant from University Hospitals Leuven (Klinische onderzoeks-en opleidingsraad). Dr. Verbrugge has reported being supported by a Fellowship of the Belgian American Educational Foundation and by the Special Research Fund of Hasselt University (BOF19PD04). Dr. Adriaenssens has received speaker fees from Abiomed. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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