Take the Active Approach with Impella™ Heart Pumps
Impella heart pump's unique mechanism of action provides:
Why Active Unloading with Impella Matters
A loaded LV may cause serious side effects including:
- Reduced myocardial perfusion due to increased wall tension
- Increased pulmonary congestion
- Increased myocardial workload and oxygen demand
- Reduced end-organ perfusion secondary to decreased cardiac output
Methods to reduce LV pressure and volume include medication, intra-aortic balloon pump (IABP), and veno-arterial extracorporeal membrane oxygenation (VA-ECMO). In patients with severe cardiogenic shock, these approaches may not provide sufficient support.
Early identification of patients who may benefit from escalation to more robust mechanical support, such as Impella, is critical.
Active Unloading with Impella
Impella heart pumps provide the unique benefit of unloading the heart while providing coronary perfusion and end organ perfusion. Impella for protected PCI, cardiogenic shock, and post-cardiotomy cardiogenic shock, is a transvalvular, active unloading device that pulls blood from the left ventricle and releases it into the aorta, providing pumping support. This active mechanical unloading of the left ventricle increases blood flow to vital organs. Impella also improves coronary perfusion by decreasing wall tension, decreasing LVEDP, and improving MAP.
What are the Latest Guidelines with Impella?
Microaxial intravascular flow pumps (mAFP), including Impella™, are now a Class IIa recommendation in recent Acute Coronary Syndrome (ACS) guidelines for patients with STEMI and severe or refractory cardiogenic shock.1 In contrast, IABP and VA‑ECMO have been downgraded to Class III due to a lack of demonstrated benefit, reflecting a shift toward active unloading strategies in contemporary shock management.2
ACC/AHA/SCAI Guideline for the management of acute coronary syndrome
Class 2a. In selected patients with STEMI and severe/refractory cardiogenic shock, microaxial flow pump is reasonable to reduce death.
Class 3. In patients with AMI and cardiogenic shock, the routine use of IABP or VA-ECMO is not recommended due to lack of survival benefits.
EACTS/STS/AATS Guideline on temporary mechanical circulatory support in adult cardiac surgery
Class 1. In patients with cardiogenic shock, it is recommended to initiate tMCS before the onset of severe organ dysfunction.
Class 2a. In patients supported with VA-ECLS, timely LV unloading should be considered.
Clinical Evidence Supporting Active Unloading with Impella
The DanGer Shock randomized controlled trial, published in The New England Journal of Medicine, demonstrated improved survival in patients with STEMI complicated by cardiogenic shock treated with Impella CPTM plus standard of care compared with standard of care alone.3,4
Interested in learning more about active unloading with Impella heart pumps?
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References
- Rao, SV., et al., (2025). 2025 ACC/AHA/ACEP/NAEMSP/SCAI Guideline for the Management of Patients With Acute Coronary Syndromes: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation, 151(13), e771-e862. https://doi.org/10.1161/CIR.0000000000001309
- Potapov, EV., et al., (2025). EACTS/STS/AATS Guidelines on temporary mechanical circulatory support in adult cardiac surgery. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery.
- Møller J, et al. (2024). Microaxial Flow Pump or Standard Care in Infarct-Related CS. New England Journal of Medicine. DOI: 10.1056/NEJMoa2312572.
- Møller J, et al. (2025). Long-Term Outcomes of the DanGer Shock Trial. New England Journal of Medicine. DOI: 10.0156/NEJM2508284.
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