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Updated: Sep 11, 2026
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
IABP versus Impella Support in Cardiogenic Shock: "In Silico" Study
Beatrice De Lazzari1, Massimo Capoccia2,3, Roberto Badagliacca4
1Human Movement and Sport Sciences, "Foro Italico" University of Rome, 00147 Rome, Italy.
Insights
This study compared Impella and Intra-Aortic Balloon Pump (IABP) support for cardiogenic shock using a cardiovascular simulator. The Impella device demonstrated a greater reduction in left ventricular volumes and workload compared to IABP.
Area of Science:
- Cardiology
- Biomedical Engineering
- Medical Simulation
Background:
- Cardiogenic shock (CS) is a critical condition characterized by severe hypotension and inadequate organ perfusion due to acute left ventricular failure.
- Mechanical circulatory support devices like Intra-Aortic Balloon Pump (IABP) and Impella pumps are crucial for managing CS.
- Comparative analysis of these devices is essential for optimizing patient outcomes.
Purpose of the Study:
- To compare the efficacy of Impella 2.5 pump versus IABP in supporting patients with cardiogenic shock.
- To evaluate hemodynamic and energetic variable changes during assistance with both devices using a cardiovascular simulator.
Main Methods:
- Utilized the CARDIOSIM© cardiovascular system simulator for virtual patient simulations.
- Simulated baseline cardiogenic shock conditions, followed by assistance with IABP (synchronized mode) and Impella 2.5 (various rotational speeds).
- Calculated percentage variations in hemodynamic and energetic variables relative to baseline during both IABP and Impella assistance.
Main Results:
- Impella 2.5 at 50,000 rpm increased total flow by 4.36% and reduced left ventricular end-diastolic volume (LVEDV) by 15-30%.
- Both IABP and Impella assistance reduced left ventricular end-systolic volume (LVESV), with IABP showing a reduction of 10-18% and Impella 12-33%.
- Impella assistance resulted in a greater reduction in LVESV, LVEDV, left ventricular external work, and left atrial pressure-volume loop area compared to IABP.
Conclusions:
- Simulation suggests Impella 2.5 offers superior hemodynamic support in cardiogenic shock compared to IABP.
- Impella demonstrates a more significant reduction in ventricular volumes and workload, indicating potentially better cardiac recovery.
- CARDIOSIM© provides a valuable platform for in-silico comparative analysis of mechanical circulatory support devices.
Abstract:
Cardiogenic shock (CS) is part of a clinical syndrome consisting of acute left ventricular failure causing severe hypotension leading to inadequate organ and tissue perfusion. The most commonly used devices to support patients affected by CS are Intra-Aortic Balloon Pump (IABP), Impella 2.5 pump and Extracorporeal Membrane Oxygenation. The aim of this study is the comparison between Impella and IABP using CARDIOSIM© software simulator of the cardiovascular system. The results of the simulations included baseline conditions from a virtual patient in CS followed by IABP assistance in synchronised mode with different driving and vacuum pressures. Subsequently, the same baseline conditions were supported by the Impella 2.5 with different rotational speeds. The percentage variation with respect to baseline conditions was calculated for haemodynamic and energetic variables during IABP and Impella assistance. The Impella pump driven with a rotational speed of 50,000 rpm increased the total flow by 4.36% with a reduction in left ventricular end-diastolic volume (LVEDV) by ≅15% to ≅30%. A reduction in left ventricular end systolic volume (LVESV) by ≅10% to ≅18% (≅12% to ≅33%) was observed with IABP (Impella) assistance. The simulation outcome suggests that assistance with the Impella device leads to higher reduction in LVESV, LVEDV, left ventricular external work and left atrial pressure-volume loop area compared to IABP support.
