Pandey Asim, Parajuli Samriddhi, Khanal Prajwal, Khanal Kunjan, Yadav Ramsinhasan Prasad
Department of Internal Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal.
Department of Medicine, Rangeli Hospital, Morang, Nepal.
Ann Med Surg (Lond). 2025 May 26;87(7):4303-4309. doi: 10.1097/MS9.0000000000003431. eCollection 2025 Jul.
Acute massive pulmonary embolism (PE) can lead to right ventricular (RV) failure and cardiogenic shock, requiring urgent treatment. Thrombolytic therapy is the standard treatment for high-risk PE in hemodynamically unstable patients. However, in cases where thrombolytics are contraindicated or ineffective, mechanical circulatory support (MCS) serves as a rescue therapy. While veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is commonly utilized, the Impella RP represents a promising advancement in MCS, offering right ventricular support in patients with PE-induced cardiogenic shock.
This narrative review evaluates the role of the Impella RP in improving hemodynamic parameters in patients with PE-induced cardiogenic shock or right ventricular failure. By reviewing available case reports and case series, we assess the effectiveness of Impella RP in improving patient outcomes.
A comprehensive literature review was conducted, obtaining data from clinical studies, case reports, case series, systematic review, and hemodynamic assessments of Impella RP in massive PE. Key parameters, including blood pressure (BP), heart rate (HR), right atrial pressure (RAP), pulmonary artery pressure (PAP), cardiac index (CI), cardiac output (CO), and overall patient outcomes, were analyzed before and after device implantation.
Our review identified 10 patients from case reports and case series in which the Impella RP was used as mechanical circulatory support (MCS) in high-risk PE patients. Hemodynamic parameters showed significant improvement following Impella RP implantation. Notably the survival rate was 100%, highlighting the role of Impella RP in managing massive PE with right ventricular failure.
The use of Impella RP in hemodynamically unstable patients with high risk PE have shown positive outcome, including improved cardiac function and hemodynamic stability. These findings suggest that Impella RP could be valuable treatment options for patients with massive PE and right heart failure. However, the limited number of reported cases highlights the need for larger-scale clinical studies and randomized trials to further assess the long-term safety, efficacy, and optimal patient selection criteria for Impella RP use.
急性大面积肺栓塞（PE）可导致右心室（RV）衰竭和心源性休克，需要紧急治疗。溶栓治疗是血流动力学不稳定的高危PE患者的标准治疗方法。然而，在溶栓治疗禁忌或无效的情况下，机械循环支持（MCS）可作为一种挽救治疗方法。虽然静脉-动脉体外膜肺氧合（VA-ECMO）是常用的，但Impella RP是MCS领域一项有前景的进展，可为PE诱发的心源性休克患者提供右心室支持。
本叙述性综述评估Impella RP在改善PE诱发的心源性休克或右心室衰竭患者血流动力学参数方面的作用。通过回顾现有病例报告和病例系列，我们评估Impella RP在改善患者预后方面的有效性。
进行了全面的文献综述，从临床研究、病例报告、病例系列、系统评价以及Impella RP在大面积PE中的血流动力学评估中获取数据。分析了设备植入前后的关键参数，包括血压（BP）、心率（HR）、右心房压（RAP）、肺动脉压（PAP）、心脏指数（CI）、心输出量（CO）以及患者总体预后。
我们的综述从病例报告和病例系列中确定了10例患者，这些患者在高危PE患者中使用Impella RP作为机械循环支持（MCS）。Impella RP植入后血流动力学参数有显著改善。值得注意的是，生存率为100%，突出了Impella RP在治疗伴有右心室衰竭的大面积PE中的作用。
在血流动力学不稳定的高危PE患者中使用Impella RP已显示出积极的结果，包括改善心脏功能和血流动力学稳定性。这些发现表明，Impella RP可能是大面积PE和右心衰竭患者的有价值的治疗选择。然而，报告病例数量有限凸显了需要进行更大规模的临床研究和随机试验，以进一步评估Impella RP使用的长期安全性、有效性和最佳患者选择标准。
