Recovering patients with cardiogenic shock using micro axial pumps

As a patient suffering from cardiogenic shock, you are facing an immense health challenge that requires immediate and intensive treatment to stabilize your condition. Cardiogenic shock occurs when the heart muscle is too weak to pump enough oxygen-rich blood throughout the body. Without treatment, cardiogenic shock can lead to life-threatening organ failure or even death. The good news is that advances in mechanical circulatory support devices have given cardiologists and surgeons powerful tools to support the failing heart during recovery. These mechanical pumps can take over the pumping function of the heart to restore adequate blood flow and allow the heart muscle to rest and heal. For those diagnosed with cardiogenic shock, the use of these mechanical circulatory support systems provides hope for survival and recovery. With the aid of technology and the expertise of medical professionals, patients can overcome this critical heart condition and get back to living full, active lives.

Understanding the Stages of Cardiogenic Shock

To properly treat a patient with cardiogenic shock, it is important to understand the progression of the condition. There are three main stages:

• Compensated shock: In the early stages, the body is still able to compensate for the pump failure and maintain adequate blood pressure and organ perfusion. However, the compensatory mechanisms, like tachycardia, vasoconstriction, and increased catecholamine release, cannot be sustained indefinitely.
• Decompensated shock: As the body's compensatory mechanisms start to fail, blood pressure drops, organ hypoperfusion worsens, and metabolic acidosis develops. At this point, pharmacological therapy and mechanical circulatory support are required to prevent irreversible end-organ damage and death.
• Refractory shock: This final stage is characterized by severe hypotension that does not respond to standard treatments like fluids, inotropes, and vasopressors. Mechanical circulatory support, such as intra-aortic balloon pumps, ventri
• cular assist devices, or extracorporeal membrane oxygenation (ECMO), may be the only option to maintain end-organ perfusion and oxygenation before heart recovery or replacement.

Understanding these stages of progression helps clinicians recognize when patients are deteriorating and escalate treatments accordingly to have the best chance of survival and recovery. Close monitoring of hemodynamic parameters, lactate, mixed venous oxygen saturation, and urine output are all essential to determine where patients lie on the spectrum and how best to support them during this critical illness. With timely and appropriate treatment at each stage, patients have the best opportunity to not only survive cardiogenic shock but thrive after recovery.

More recently, the Society for Cardiovascular Angiography & Interventions created a SCAI SHOCK classification to provide a standardized vocabulary for physicians and researchers to use across all clinical settings.

How the Impella Heart Pump Works to Support Cardiogenic Shock Patients

There are several heart pumps and mechanical devices used to support the heart and cardiovascular system in patients with cardiogenic shock. These include extracorporeal membrane oxygenation ( ECMO), Tandem heart device and the Impella micro-axial pumps.

I will describe the Impella device more in detail as this is the most commonly used mechanical support device currently used. The Impella pump is inserted through a small incision in the leg or a cut down via a graft and the device is guided into the left ventricle.

Once in place, the Impella pump draws oxygenated blood from the left ventricle and pumps it out to the rest of the body, reducing the heart's workload. This allows the heart muscle to rest while maintaining blood flow throughout the body. The Impella pump can provide support for days to weeks, giving the heart time to recover.

There are three broad Impella pump models:

• Impella 2.5 - provides up to 2.5 liters of blood flow per minute. Typically used for patients with small body surface area or when less support is needed.
• Impella CP - provides up to 3.7 liters of blood flow per minute. The most commonly used model for patients with cardiogenic shock.
• Impella 5.5 - provides up to 5.5 liters of blood flow per minute. Used for patients who require maximum support. This requires a cutdown to implant.

The Impella pump is implanted without stopping the heart, using a minimally invasive technique. It is designed to reduce trauma to the heart and blood vessels. The pump remains outside the body with just the small catheter entering the leg artery up to the left ventricle. This allows for quick placement and easy removal once a patient has recovered.

With the Impella pump, physicians have an effective tool to support patients in cardiogenic shock. The Impella pump provides immediate circulatory support, stabilizing the patient and maximizing the chance of heart muscle recovery and survival.

Case Studies: Patients Successfully Recovered From Cardiogenic Shock Using Impella

Patient 1

A 76-year-old male presented with acute myocardial infarction complicated by cardiogenic shock. An Impella CP was inserted for circulatory support. After 3 days of support, the patients hemodynamics improved with increasing cardiac index and mixed venous oxygen saturation and decreasing lactate levels. The Impella CP was explanted, and the patient was discharged home on Day 12 without the need for further circulatory support or ventricular assist device implantation.

Patient 2

A 55-year-old female with a history of coronary artery disease and previous coronary artery bypass grafting surgery presented with recurrent angina and cardiac arrest with pulseless electrical activity. She required cardiopulmonary resuscitation and intubation, followed by Impella 5.5 implantation through a cut down in the right axillary artery for circulatory support. Her hemodynamics and end-organ function improved over the next 3 days. The Impella was explanted, and she was discharged home without further circulatory support after 2 weeks.

In both cases, the Impella heart pump was able to provide critical circulatory support during a period of acute hemodynamic compromise, allowing the heart muscle to rest and recover. This highlights the potential of short-term mechanical circulatory support to enable recovery of myocardial function and avoid the need for long-term left ventricular assist device support or heart transplantation in selected patients. With prompt recognition of cardiogenic shock and institution of appropriate mechanical circulatory support, patients can survive what was once considered a terminal event.

The use of mechanical circulatory support in the form of Impella axial flow heart pumps has expanded the treatment options for patients in cardiogenic shock, allowing for heart recovery and survival without permanent ventricular assist device implantation or cardiac transplantation. These case studies demonstrate that with the availability of short-term mechanical circulatory support, patients who were previously considered too ill to recover now have a chance for meaningful survival.

Conclusion

As you recover from cardiogenic shock, the road ahead requires patience and perseverance. Though the initial crisis may have passed, the body needs time to heal. Follow the guidance of your medical team closely regarding medication, lifestyle changes, and rehabilitation. Make the necessary adjustments to support your recovery and long-term health. Difficult days may still arise, but stay focused on your progress and maintaining an optimistic outlook. With the aid of mechanical circulatory support, many patients are able to regain strength and function. Stay committed to your health and wellness, appreciate each milestone achieved, and keep your eyes on the future. Full recovery is absolutely possible if you make your health the top priority. The human spirit is resilient, so believe in your ability to overcome this challenge.