Impella

Impella is a device used as a temporary ventricular support device in people with depressed heart function. It is an option for right heart support along with ECMO and Centrimag.

The device is approved for use in high-risk percutaneous coronary intervention (PCI) and cardiogenic shock following a heart attack or an open heart surgery procedure. It is placed into the heart through a peripheral artery. Once in place, it pump blood for the left or right side of the heart, pumping blood into the ascending aorta or pulmonary artery, respectively.

It results in similar results to veno-arterial extracorporeal life support and TandemHeart.

The Impella pump is in 7 sets of practice guidelines:

Impella heart pumps are percutaneous microaxial pumps that act as mechanical circulatory support (MCS) devices in patients in need of hemodynamic support. The pumps are mounted on a 9 Fr support catheter. The pumps are inserted by a physician typically through femoral artery access, although axillary and subclavian artery approaches are not uncommon.

The Impella heart pumps are designed to provide hemodynamic support when the patient's heart is unable to produce sufficient cardiac output. The Impella family of heart pumps can supply 1.0 L/min-5.0 L/min of blood flow, depending on the size and power setting of the individual pump. The physiological consequences of left-sided support are threefold. First, it unloads the left ventricle by reducing left ventricular end-diastolic volume and pressure, which decreases ventricular wall stress. Subsequently, left ventricular work and myocardial oxygen demand decrease. Second, Impella pump flow increases mean arterial pressure, diastolic pressure, and cardiac output. This increases cardiac power output and cardiac index. The combined effects of the Impella on wall stress and perfusion pressure (especially diastolic pressure) augment coronary perfusion. Lastly, augmented cardiac output and forward flow from the left ventricle has secondary benefits related to right ventricular function. Impella support decreases pulmonary capillary wedge pressure and reduces right ventricular afterload.

In June 2008, the Impella 2.5 heart pump received FDA 510(k) clearance for partial circulatory support for periods of up to 6 hours during cardiac procedures not requiring cardiopulmonary bypass. In March 2015, the Impella 2.5 heart pump received FDA Premarket Approval (PMA) for elective and urgent high-risk PCI procedures, and in December 2016, the FDA PMA was expanded to include the Impella CP heart pump. In April 2009, the Impella 5.0 and Impella LD heart pumps received FDA 510(k) clearance for circulatory support for periods of up to 6 hours during cardiac procedures not requiring cardiopulmonary bypass. In July 2010, the Automated Impella Controller received FDA 510(k) clearance for intended use by trained healthcare professionals in healthcare facilities and medical transport (ie, ambulance, helicopter, or fixed-wing aircraft) environments.

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