Support with intra-aortic balloon pump vs. Impella2.5® and blood flow to the heart, brain and kidneys - An experimental porcine model of ischaemic heart failure

Background Cardiogenic shock as a complication to an acute myocardial infarction has an unacceptably high death rate that has not changed for the last 15 years. Mortality is partly related to organ hypoperfusion and mechanical assist devices are used for the most severe cases but we do not know which assist device is the best option. Therefore, we have investigated how an IABP and an Impella®-pump influenced blood flow to the brain, heart and kidneys, in a closed-chest porcine model of severe left ventricular failure.

Methods 13 pigs were anesthetised and left ventricular failure was induced by occluding the proximal LAD for 45 min followed by 30 min of reperfusion. Blood flow was measured in the carotid artery, the LAD, and the renal artery. The Impella® and IABP were inserted via the femoral arteries, and the two devices were tested individually and combined after induction of heart failure.

Results Carotid- (p = 0.01) and renal blood flow (p = 0.045) were higher on Impella®-support, compared to no support. None of the devices altered the blood flow in the LAD. Cardiac power output (p < 0.005) and left ventricular work (p < 0.00) were also higher on Impella®-support compared to no support.

Conclusion Haemodynamics and blood flow to the brain and kidneys were significantly better on Impella®-support, suggesting that the Impella® is superior to the IABP in a state of ischaemia induced left ventricular failure. These data, however, needs to be confirmed in a proper clinical trial with patients in cardiogenic shock.