Acute Kidney Injury (AKI), AMI Cardiogenic Shock, Protected PCI
Renal Protection and Hemodynamic Improvement by Impella® Heart Pumps
Birgit Markus, MD, senior physician and head of intensive care medicine, Universitätsklinikum Marburg, discusses her article from the Journal of Clinical Medicine titled, “Renal protection and hemodynamic improvement by Impella® microaxial pump in patients with cardiogenic shock.”
Dr. Markus explains, “We evaluated the effect of Impella® [heart pumps] on hemodynamics with a particular focus on renal perfusion in order to get an idea of how to preserve renal organ function in cardiogenic shock that has been reported during elective protected PCI.” She describes the study, which enrolled 50 patients with infarct-associated cardiogenic shock being treated with Impella CP® heart pumps, and explains how they calculated renal resistive index (RRI), a parameter considered to be an early predictor of renal failure.
“The Impella flow reduces renal resistive index, which means, renal perfusion might improve during Impella [heart pump] support,” she states. In the study, researchers also observed that Impella heart pump support is associated with significant improvement in cardiac output, cardiac index, and central venous oxygen saturation, and reduction in systemic vascular resistance. “These findings, in total, demonstrate an improved hemodynamic condition during Impella [heart pump] support.”
Dr. Markus also discusses how glomerular filtration rate (GFR) increased during short-term follow-up and how the need for renal replacement therapy was significantly higher in patients with RRI above 0.8 during Impella heart pump support.
Summarizing the main benefits of Impella with regard to renal function in cardiogenic shock, Dr. Markus states, “In cardiogenic shock, Impella not only improves hemodynamics, and cardiac output, and optimized cardiac output also reduces vascular resistance, and accordingly myocardial afterload, improving myocardial recovery, which is very important too. And after hemodynamic stabilization due to an increased cardiac output, Impella heart pump support often allows a reduction of vasopressor dosages, which results in an additional improvement, for example, of renal perfusion. Thus, as we could demonstrate here, Impella device support might protect against the prognostically relevant loss of renal organ function in cardiogenic shock and this has to be further investigated in clinical trials now.”
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