Department of Cardiology, AMC Heart Center, Academic Medical Center, Amsterdam, The Netherlands.
Crit Care Med. 2011 Sep;39(9):2072-9. doi: 10.1097/CCM.0b013e31821e89b5.
Cardiogenic shock remains an important therapeutic challenge, with high in-hospital mortality rates. Mechanical circulatory support may be beneficial in these patients. Since the efficacy of the intra-aortic balloon pump seems limited, new percutaneously placed mechanical left ventricular support devices, such as the Impella system, have been developed for this purpose. Our current purpose was to describe our experience with the Impella system in patients with ST-elevation myocardial infarction presenting in profound cardiogenic shock, who were admitted to our intensive care unit for mechanical ventilation.
From January 2004 through August 2010, a total of 34 ST-elevation myocardial infarction patients with profound cardiogenic shock were admitted to our intensive care unit and treated with either the Impella 2.5 or the Impella 5.0 device. Baseline and follow-up characteristics were collected retrospectively.
Within the study cohort, 25 patients initially received treatment with the Impella 2.5, whereas nine patients received immediate Impella 5.0 support. Eight out of 25 patients in the Impella 2.5 group were upgraded to 5.0 support. After 48 hrs, 14 of 25 patients in the 2.5 group were alive, five of whom had been upgraded. In the 5.0 group, eight out of nine patients were alive. After 30 days, six of 25 patients in the 2.5 group were alive, three of whom had been upgraded. In the 5.0 group, three of nine patients were alive at 30 days.
In ST-elevation myocardial infarction patients with severe and profound cardiogenic shock, our initial experience suggests improved survival in patients who received immediate Impella 5.0 treatment, as well as in patients who were upgraded from 2.5 to 5.0 support, when compared to patients who received only Impella 2.5 support.
心原性休克仍然是一个重要的治疗挑战，院内死亡率很高。机械循环支持可能对这些患者有益。由于主动脉内球囊泵的疗效似乎有限，因此已经开发了新的经皮放置的机械左心室支持装置，如 Impella 系统，用于此目的。我们目前的目的是描述我们在因机械通气而入住重症监护病房的 ST 段抬高型心肌梗死合并严重心原性休克患者中使用 Impella 系统的经验。
从 2004 年 1 月至 2010 年 8 月，共有 34 例 ST 段抬高型心肌梗死合并严重心原性休克的患者入住我们的重症监护病房，并接受 Impella 2.5 或 Impella 5.0 装置治疗。回顾性收集基线和随访特征。
在研究队列中，25 例患者最初接受 Impella 2.5 治疗，而 9 例患者接受立即 Impella 5.0 支持。25 例 Impella 2.5 组中有 8 例升级为 5.0 支持。在 48 小时后，25 例 Impella 2.5 组中有 14 例存活，其中 5 例升级。在 5.0 组中，9 例中有 8 例存活。在 30 天后，25 例 Impella 2.5 组中有 6 例存活，其中 3 例升级。在 5.0 组中，9 例中有 3 例在 30 天后存活。
在 ST 段抬高型心肌梗死合并严重和严重心原性休克的患者中，我们的初步经验表明，与仅接受 Impella 2.5 支持的患者相比，立即接受 Impella 5.0 治疗的患者以及从 2.5 升级到 5.0 支持的患者的存活率有所提高。
