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Related Concept Videos

Heart Failure Drugs: Inotropic Agents01:26

Heart Failure Drugs: Inotropic Agents

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Positive inotropic agents are commonly used as the first line of treatment for heart failure. One such agent is digoxin, derived from the genus Digitalis, which has been known for centuries but effectively utilized since 1785. However, these cardiac glycosides can have potentially toxic effects due to their mechanism of action, which involves inhibiting Na+/K+-ATPase and increasing contractility. Digoxin is absorbed orally and distributed in various tissues, including the CNS. It has a long...
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Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
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Related Experiment Video

Updated: May 24, 2025

Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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ECPella 5+ in Patients With Cardiogenic Shock: Potential for Improved Outcomes.

Nicoletta D'Ettore1, Astrid Cardinale2, Giulia Maj2

  • 1Department of Cardiology, San Giacomo Hospital, Novi Ligure, Alessandria, Italy.

Journal of Cardiothoracic and Vascular Anesthesia
|February 28, 2025
PubMed
Summary

Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with Impella 5+ may improve outcomes in cardiogenic shock patients. This ECPella 5+ therapy showed a lower mortality rate compared to other ECPella combinations, warranting further investigation.

Keywords:
ECPellacardiogenic shockmechanical circulatory supportmortality

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Area of Science:

  • Cardiology
  • Mechanical Circulatory Support
  • Critical Care Medicine

Background:

  • Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is a critical treatment for cardiogenic shock (CS).
  • Combining VA-ECMO with Impella (ECPella) improves patient outcomes.
  • Limited comparative data exists for different Impella generations used in ECPella therapy.

Purpose of the Study:

  • To evaluate the clinical outcomes of ECPella therapy specifically using the Impella 5+ device in patients with cardiogenic shock.
  • To compare the efficacy of ECPella 5+ against other ECPella configurations and a contemporary patient cohort.

Main Methods:

  • A systematic review of 84 studies published in PubMed (January 2017 - October 2023) focusing on ECPella in CS.
  • Full analysis of 24 selected articles to extract data on ECPella 5+ usage and outcomes.
  • Comparison of findings with a cohort of 10 patients treated with ECPella 5+ (January 2022 - May 2023).

Main Results:

  • The use of ECPella 5+ has increased, comprising over 50% of ECPella configurations in studies from 2023.
  • The mortality rate for ECPella 5+ was 33% (in 5 studies) compared to 49% for all ECPella combinations.
  • The observed mortality rate in the contemporary ECPella 5+ cohort was 30%, aligning with published data.

Conclusions:

  • Impella 5+ may offer further benefits in improving outcomes for patients undergoing ECPella therapy for cardiogenic shock.
  • Current findings are limited by small sample sizes and the descriptive nature of the data.
  • Larger, prospective studies are necessary to confirm these benefits and assess impacts on complication rates and native heart recovery.