Cardiogenic Shock

A cardiogenic shock is a life-threatening situation that occurs when the heart’s inability to function causes organs in the body to fail. This may lead to multiorgan failure and can result in the patient’s death. The Impella heart pump can secure blood supply and provide a way out of the life-threatening situation.

Cardiogenic Shock
The graphic shows the position of the Impella heart pumps

Cardiogenic Shock

A cardiogenic shock is a life-threatening condition which is caused by the massive reduction of the heart’s pumping function.

This may lead to:

  • A lower ejection fraction
  • Reduced contractility
  • Low blood pressure
  • Coronary insufficiency

The heart is no longer able to provide the required cardiac output for the supply of vital organs.

Untreated, a cardiogenic shock can lead to multiorgan failure and ultimately to the death of a patient.

The cause of a cardiogenic shock is usually a pre-existing heart condition. In about 80% of cases, a heart attack is caused by the failure of the left ventricle. Rarely, heart valve damage or myocarditis trigger a cardiogenic shock.

Shock spiral

During a cardiogenic shock the blood volume flowing through the body suddenly decreases. Thus, the heart’s inability to function leads to an oxygen deficiency within vital organs, which in turn leads to increased anaerobic decomposition processes within the body.

Because this metabolic pathway does not require oxygen, the process is not fully completed. This leads to acidosis (hyperacidity of the blood), which causes the arterioles to slacken and damages the blood capillaries.

In addition, a loss of fluid takes place, that increases hypovolaemia (volume deficit). Furthermore, this leads to an accumulation of blood within the capillaries, which might lead to microthromboses. The entire process continues to intensify independently of its cause and is therefore referred to as a shock spiral.

Of all the patients suffering from cardiogenic shock, 50 to 80 % die because of circulatory or end-organ failure. Systems for circulatory support such as the Impella heart pump can improve hemodynamics and promote the recovery of the heart muscle. ¹

Downward spiral during cardiogenic shock

The Impella Heart Pump Can Save Lives During Cardiogenic Shock

The therapeutic standard for a cardiogenic shock is an early revascularization as well as the treatment with inotropes and catecholamines. However, drugs are only effective when sufficient healthy myocardium remains.

Alternatively, percutaneous mechanical support can provide a way out of the life-threatening situation. Impella heart pumps can be used for this purpose. They improve hemodynamics and stimulate the recovery of the heart muscle.

Positive effects

The Impella heart pump is a left ventricular heart support system for intracorporal use. When using Impella catheters, the ejection fraction increases while simultaneously reducing the heart’s work. This unloads the ventricle and coronary circulation improves. Thus, myocardial oxygen consumption and demand are better balanced.

The Impella catheter also increases the systemic aortic pressure and mean arterial pressure. Overall, the changes induced by the Impella heart pump optimize the conditions for a natural recovery of the heart ²,³

Hemodynamic effects of Impella heart support systems

Clinical Evidence

The evidence for cardiovascular and survival benefits with the use of Impella heart pumps in cardiogenic shock comes from numerous studies and publications:

Prospective study ISAR-SHOCK 4

  • The prospective ISAR-SHOCK study with a total of 25 patients showed that the Impella 2.5® heart pump provides better hemodynamic support than the standard therapy with an intra-aortic balloon pump (IABP) in cardiogenic shock.

Retrospective evaluation of 47 patients 5

  • Retrospectively, data from 47 patients with an average age of 60 years were analyzed. 32 patients had a cardiogenic shock post cardiotomy, 15 patients had a cardiogenic shock due to other causes.
  • For 72 % of the patients (34/47), ventricular function recovered.
  • The 30-day mortality rate for this high-risk group was 25 % and therefore significantly lower than the usually observed mortality rate of 50 %.

Dresdner Impella-Register 6

  • Out of 43 patients enrolled in the Dresden Impella Registry, 14 patients had received an Impella heart pump due to an infarct-related cardiogenic shock.
  • The infarcted vessel was revascularized in all patients.
  • In comparison to IABP support, the Impella system resulted in faster hemodynamic stabilization with lower vasopressor consumption.
  • In addition, the Impella catheter increased the lactate clearance as an expression of improved microcirculation.

 

Sources

  1. Gilani FS, et al. Percutaneous Mechanical Support in Cardiogenic Shock: A Review. Clin Med Insights Cardiol. 2015; 9: 23–28.
  2. Lam K, et al. Improved microcirculation in patients with an acute ST-elevation myocardial infarction treated with the Impella LP2.5 percutaneous left ventricular assist device. Clin Res Cardiol. 2009; 98: 311–18.
  3. Anderson MB et al. Benefits of a novel percutaneous ventricular assist device for right heart failure. The prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant. 2015, 34: 1549-60.
  4. Seyfarth M, et al. A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardiogenic shock caused by myocardial infarction. J Am Coll Cardiol. 2008;52: 1584–88.
  5. Lemaire A, et al. The Impella device for acute mechanical circulatory support in patients in cardiogenic shock. Ann Thorac Surg. 2014;97: 133–38.
  6. Schweigler T, et al. Perkutane linksventrikuläre Unterstützung mittels Axialpumpe vs. intraaortaler Gegenpulsation im infarktbedingten kardiogenen Schock: Daten aus dem Dresdner Impeller-Register (DIR). Clin Res Cardiol. 2015;104 Suppl 1: V1154.

Related literature:

  • Werdan K, et al. Deutsch-österreichische S3-Leitlinie Infarktbedingter kardiogener Schock. Diagnose, Monitoring und Therapie. Kardiologe. 2011; 5: 166–224.
  • Anderson MB et al. Benefits of a novel percutaneous ventricular assist device for right heart failure. The prospective RECOVER RIGHT study of the Impella RP device. J Heart Lung Transplant. 2015, 34: 1549-60.
  • O'Neill WW, et al. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol. 2014;27: 1–11.

 

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