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Updated: May 21, 2025
Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
First results of the 'Deutsches Herzzentrum der Charite' paediatric impella cohort
Kira Kuschnerus1,2, Evgenij Potapov3, Pia Lanmüller3
1Department of Congenital Heart Surgery-Pediatric Heart Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany.
Insights
Impella devices offer a safe and feasible option for mechanical circulatory support in pediatric patients experiencing cardiogenic shock. This study highlights successful bridging to recovery, left ventricular assist devices, or transplantation with no mortality or neurological complications.
Area of Science:
- Pediatric Cardiology
- Mechanical Circulatory Support
- Pediatric Critical Care
Background:
- Mechanical support for pediatric low cardiac output syndrome is limited, often relying on extracorporeal life support or ventricular assist devices.
- Transferring microaxial flow pump technology from adults to pediatrics requires defining patient selection and support parameters.
Purpose of the Study:
- To evaluate the feasibility and safety of using Impella devices for mechanical circulatory support in pediatric patients with cardiogenic shock.
- To identify patient selection criteria, optimal support duration, and bridging strategies for pediatric Impella use.
Main Methods:
- Single-center retrospective observational study.
- Inclusion of pediatric patients (<18 years) with cardiogenic shock treated exclusively with Impella devices from 2022 to 2024.
Main Results:
- Six patients (median age 12 years) received Impella support (2.5, CP, 5.5) for various heart failure etiologies.
- Median support duration was 7 days; 2 patients recovered, 3 bridged to ventricular assist devices, and 1 to transplantation.
- No mortality or neurological complications were observed.
Conclusions:
- Left ventricular unloading with Impella is feasible and safe in pediatric cardiogenic shock.
- Larger Impella devices in older pediatric patients may allow for longer support durations.
Objectives:
Mechanical support options for children and small adolescents in low cardiac output syndrome or cardiogenic shock are often still limited to veno arterial extracorporeal life support and subsequent left or biventricular assist device implantation. We aim to transfer mechanical support options with microaxial flow pump devices from the adult to the paediatric population and therefore aim to identify patient selection criteria and evaluate possible support duration and bridging modalities in a paediatric Impella registry.
Methods:
This is a single-centre retrospective observational study including every patient <18 years presenting with cardiogenic shock and treated with an Impella device only from 2022 to 2024.
Results:
The study cohort included 6 patients with a median age of 12 (3-17 years), median weight of 35.6 kg (12-115 kg) and a median body surface area (BSA) of 1.2 m2 (0.57-2.4 m2). Intermacs levels were 2 (4 patients) and 3 (2 patients). Heart failure aetiologies were dilative cardiomyopathy (3 patients), myocarditis (1 patient), acute rejection after cardiac transplantation (1 patient) and low cardiac output syndrome after complex endocarditis surgery (1 patient). The implanted devices were an Impella 2.5 [1], Impella CP [2] and Impella 5.5 [3]. Median support duration was 7 (4-45) days. Two patients could be bridged to recovery. Three patients were bridged to an left ventricular assist device, and 1 patient was bridged to cardiac transplantation. We observed no mortality and no neurological complications.
Conclusions:
Left ventricular unloading in cardiogenic shock in children and adolescents using an Impella is feasible and safe. In older patients allowing for implantation of larger devices, a longer support duration is possible.
