Impella is not a simple “more support means better outcome” device: across 194 references and 432 original studies, the evidence shows a constant trade-off between ventricular unloading, survival signals, and complications such as bleeding, hemolysis, thrombocytopenia, vascular injury, and acquired von Willebrand syndrome. The full ☸️SAIMSARA evidence map shows where Impella appears strongest — early AMI-cardiogenic shock support, high-risk PCI, bridge-to-transplant/LVAD pathways, and selected RV failure scenarios — and where the evidence remains fragile, observational, or safety-limited.
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Abstract: To synthesize original evidence on Impella devices, focusing on clinical indications, outcomes, complications, device-management strategies, access and weaning approaches, bridge-to-therapy roles, and emerging implementation themes across adult and pediatric populations. The review uses 194 references and builds its evidence map from 432 original studies with 989377 total participants/sample observations (topic-deduplicated ΣN). This scoping review indicates that Impella functions as a versatile temporary mechanical circulatory support platform whose clinical value is highly context-dependent, shaped by shock severity, timing of initiation, device selection, and complication management. The most consistent signal supports a role for early, pre-PCI initiation in AMI-cardiogenic shock, reinforced by the DanGer Shock trial showing reduced 180-day mortality with routine Impella CP alongside increased composite adverse events. Across indications, recurrent themes of bleeding, hemolysis, vascular injury, and acquired von Willebrand syndrome highlight that hemodynamic benefit is closely counterbalanced by device-associated harm, with serious bleeding reported in up to 62% of supported patients in some cohorts. Larger Impella 5.0/5.5 platforms appear especially relevant for bridge-to-decision and bridge-to-transplant pathways, with selected cohorts reporting 90.3% 1-year post-transplant survival. Future randomized trials should clarify optimal timing, escalation thresholds, and anticoagulation strategies within phenotyped shock populations to resolve the persistent tension between circulatory support and device-related complications.
Final search date and database lock: 2026-05-15 21:28:19 CEST
Plan: Pro (expanded craft tokens; source: Semantic Scholar)
Source: Semantic Scholar
Total Abstracts/Papers: 4614686
Downloaded Abstracts/Papers: 1000
Included original and non-original Abstracts/Papers (all): 533
Included original Abstracts/Papers (Vote counting by direction of effect): 432
Reference Index (links used in paper): 194
Total participants/sample observations (topic deduplicated ΣN): 989377
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[3] Impella device in Fulminant Myocarditis: Japanese Registry for Percutaneous Ventricular Assist Device (J-PVAD) registry analysis on outcomes and adverse events. — https://doi.org/10.1093/ehjacc/zuad149
[7] Analysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device — https://doi.org/10.1016/j.ahj.2018.03.024
[10] Left ventricular unloading during extracorporeal life support for myocardial infarction with cardiogenic shock: surgical venting versus Impella device — https://doi.org/10.1093/icvts/ivab230
[21] Left heart Impella-device to bridge acute mitral regurgitation to MitraClip-procedure: a novel implementation of percutaneous mechanical circulatory support — https://doi.org/10.1093/ehjci/ehaa946.1849
[32] Impella - Current issues and future expectations for the percutaneous, microaxial flow left ventricular assist device. — https://doi.org/10.1016/j.jjcc.2023.10.008
[33] Mechanical Assist Device-Assisted Percutaneous Coronary Intervention: The Use of Impella Versus Extracorporeal Membrane Oxygenation as an Emerging Frontier in Revascularization in Cardiogenic Shock — https://doi.org/10.7759/cureus.33372
[36] Cardiac Rehabilitation in Severe Heart Failure Patients with Impella 5.0 Support via the Subclavian Artery Approach Prior to Left Ventricular Assist Device Implantation — https://doi.org/10.3390/jpm13040630
[37] Analysis of Bicarbonate-Based Purge Solution in Patients With Cardiogenic Shock Supported Via Impella Ventricular Assist Device — https://doi.org/10.1177/10600280221124156
[42] Complex High-Risk Indicated Percutaneous Coronary Intervention With Prophylactic Use of the Impella CP Ventricular Assist Device. — https://doi.org/10.25270/jic/22.00031
[45] Prevalence and Severity of Aortic Regurgitation Due to a Percutaneous Left Ventricular Assist Device (Impella 5.0): A Retrospective Observational Study. — https://doi.org/10.1053/j.jvca.2022.10.010
[51] Budget Impact Associated with the Introduction of the Impella 5.0® Mechanical Circulatory Support Device for Cardiogenic Shock in France — https://doi.org/10.2147/ceor.s278269
[54] Use of Transcarotid IMPELLA 2.5 Axial-Flow Pump Device for Left Ventricle Unloading During VA-ECMO Support in Pediatric Acute Heart Failure — https://doi.org/10.1177/21501351211017866
[56] A case of left ventricular free wall rupture after insertion of an IMPELLA® left ventricular assist device diagnosed by transesophageal echocardiography — https://doi.org/10.1186/s40981-021-00444-w
[61] Direct bridging to cardiac transplantation with the surgically implanted Impella 5.0 device — https://doi.org/10.1111/ctr.13818
[66] Left Impella®-device as bridge from cardiogenic shock with acute, severe mitral regurgitation to MitraClip®-procedure: a new option for critically ill patients. — https://doi.org/10.1093/ehjacc/zuaa031
[67] Analysis of Adverse Events Related to Impella® Usage (From the Manufacturer and User Facility Device Experience and National Inpatient Sample Databases). — https://doi.org/10.1016/j.amjcard.2020.10.056
[71] Survey of Anticoagulation Practices with the Impella Percutaneous Ventricular Assist Device at High-Volume Centers — https://doi.org/10.1155/2019/3791307
[74] Adverse Events and Modes of Failure Related to Impella RP: Insights from the Manufacturer and User Facility Device Experience (MAUDE) Database. — https://doi.org/10.1016/j.carrev.2019.03.010
[92] Mechanical Circulatory Support for Semi – elective PCI in High-risk Patients with Extracorporeal Membranous Oxygenation (ECMO) Compared to Impella Heart Pump Device — https://doi.org/10.1016/j.hlc.2019.06.656
[96] Safety and feasibility of a novel total percutaneous post-closure technique after bedside Impella decannulation in patients with cardiogenic shock. — https://doi.org/10.25270/jic/23.00255
[102] Structured Weaning From the Impella Left Ventricular Micro-Axial Pump in Acute Myocardial Infarction With Cardiogenic Shock and Protected Percutaneous Coronary Intervention: Experience From a Non-Cardiac Surgical Centre. — https://doi.org/10.1016/j.hlc.2023.12.007
[107] SAICR‐CTO: Single Access Impella‐Guided Complete Revascularization in Chronic Total Occlusion—A Novel Approach to High‐Risk PCI — https://doi.org/10.1002/ccd.31277
[109] Improved clinical outcomes associated with the Impella 5.5 compared to the Impella 5.0 in contemporary cardiogenic shock and heart failure patients. — https://doi.org/10.1016/j.healun.2023.01.011
[110] Prolonged circulatory support with an Impella assist device in the management of cardiogenic shock associated with takotsubo syndrome, severe sepsis and acute respiratory distress syndrome — https://doi.org/10.1177/2050313x17741013
[113] Impella Support for Acute Myocardial Infarction Complicated by Cardiogenic Shock: Matched-Pair IABP-SHOCK II Trial 30-Day Mortality Analysis — https://doi.org/10.1161/circulationaha.118.036614
[120] Impella for the Management of Ventricular Septal Defect Complicating Acute Myocardial Infarction: A European Multicenter Registry — https://doi.org/10.1097/mat.0000000000002060
[124] Sex-Related Differences in Short-Term Prognosis in Patients with Acute Myocardial Infarction-Related Cardiogenic Shock Receiving Impella Support in Japan: From the J-PVAD Registry — https://doi.org/10.3390/medicina59071208
[128] Management of patients with impella devices or intra-aortic balloon pumps during helicopter air ambulance transport in observational data — https://doi.org/10.1177/02676591231158273
[135] Comparative Healthcare Resource Utilization of percutaneous mechanical circulatory support using Impella versus intra-aortic balloon pump use for Patients with Acute Coronary syndrome and Cardiogenic Shock Undergoing Percutaneous Coronary Interventions: Insights from National Inpatient Sample. — https://doi.org/10.1016/j.cpcardiol.2023.102053
[137] Access Site-Stratified Analysis of the Incidence, Predictors, and Outcomes of Impella-Supported Patients With Cardiogenic Shock. — https://doi.org/10.1016/j.amjcard.2023.07.134
[140] Timing of impella placement in PCI for acute myocardial infarction complicated by cardiogenic shock: An updated meta-analysis. — https://doi.org/10.1016/j.ijcard.2022.05.011
[143] Meta-Analysis Comparing Venoarterial Extracorporeal Membrane Oxygenation With or Without Impella in Patients With Cardiogenic Shock. — https://doi.org/10.1016/j.amjcard.2022.06.059
[144] Simultaneous Venoarterial Extracorporeal Membrane Oxygenation and Percutaneous Left Ventricular Decompression Therapy with Impella Is Associated with Improved Outcomes in Refractory Cardiogenic Shock — https://doi.org/10.1097/mat.0000000000000767
[145] ECMO and Impella Support Strategies as a Bridge to Surgical Repair of Post-Infarction Ventricular Septal Rupture — https://doi.org/10.3390/medicina58050611
[149] Impella support versus intra-aortic balloon pump in acute myocardial infarction complicated by cardiogenic shock: A meta-analysis. — https://doi.org/10.1016/j.carrev.2021.01.028
[153] Venoarterial Extracorporeal Membrane Oxygenation With Concomitant Impella Versus Venoarterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock — https://doi.org/10.1097/mat.0000000000001039
[154] A Comparison of In-Hospital Outcomes Between the Use of Impella and IABP in Acute Myocardial Infarction Cardiogenic Shock Undergoing Percutaneous Coronary Intervention. — https://doi.org/10.25270/jic/21.00096
[156] Effect of Impella 5.5 on Preexisting Functional Mitral Regurgitation in Patients with Heart Failure–Related Cardiogenic Shock — https://doi.org/10.1016/j.shj.2022.100072
[159] Save the Leg: Utilization of Distal Perfusion Catheter With Impella CP® May Prevent Morbidity of Limb — https://doi.org/10.7759/cureus.29916
[161] Mechanical circulatory support in cardiogenic shock from acute myocardial infarction: Impella CP/5.0 versus ECMO — https://doi.org/10.1177/2048872619865891
[162] Antithrombotic management for Impella® temporary ventricular assist devices: An analysis of an academic health-system experience — https://doi.org/10.1177/03913988221082686
[168] Outcomes of Impella compared with intra-aortic balloon pump in ST-elevation myocardial infarction complicated by cardiogenic shock — https://doi.org/10.1016/j.ahjo.2021.100067
[183] The Single-Access Technique for Impella Protected Percutaneous Coronary Intervention: A Single-Center Experience. — https://doi.org/10.25270/jic/21.00101
[188] Six months follow-up of protected high-risk percutaneous coronary intervention with the microaxial Impella pump: results from the German Impella registry — https://doi.org/10.1097/mca.0000000000000824
[190] Removal of Impella in the Setting of Left Ventricular Thrombus: A Potential Indication for Cerebral Embolic Protection Devices — https://doi.org/10.11589/vad/e2021714
[201] Clinical Outcomes of Impella Microaxial Devices Used to Salvage Cardiogenic Shock as a Bridge to Durable Circulatory Support or Cardiac Transplantation. — https://doi.org/10.1097/mat.0000000000000877
[202] Impella RP support in refractory right ventricular failure complicating acute myocardial infarction with unsuccessful right coronary artery revascularization. — https://doi.org/10.1016/j.ijcard.2019.12.024
[203] Long term survival after early unloading with Impella CP® in acute myocardial infarction complicated by cardiogenic shock — https://doi.org/10.1177/2048872618815063
[206] Survival after refractory cardiogenic shock is comparable in patients with Impella and veno-arterial extracorporeal membrane oxygenation when adjusted for SAVE score — https://doi.org/10.1177/2048872618799745
[228] Impella RP Support and Catheter-Directed Thrombolysis to Treat Right Ventricular Failure Caused by Pulmonary Embolism in 2 Patients. — https://doi.org/10.14503/thij-17-6316
[230] Mitraclip treatment for severe mitral regurgitation due to chordae rupture following Impella CP support in a patient with severe aortic stenosis. — https://doi.org/10.1016/j.carrev.2020.08.027
[234] Sex-Related Differences in Outcome of Patients Treated With Microaxial Percutaneous Left Ventricular Assist Device for Cardiogenic Shock. — https://doi.org/10.1016/j.hlc.2024.07.010
[236] Temporary Mechanical Circulatory Support During Bariatric Surgery: A Novel Bridge to Durable Left Ventricular Assist Device and Cardiac Transplantation — https://doi.org/10.1177/00031348241244637
[241] The Impella Microaxial Flow Catheter Is Safe and Effective for Treatment of Myocarditis Complicated by Cardiogenic Shock: An Analysis From the Global cVAD Registry. — https://doi.org/10.1016/j.cardfail.2018.09.007
[245] Loperamide overdose causing torsades de pointes and requiring Impella temporary mechanical support: a case report — https://doi.org/10.1093/ehjcr/ytz150
[247] Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock: JACC Review Topic of the Week. — https://doi.org/10.1016/j.jacc.2022.02.052
[252] The Impella Recover microaxial left ventricular assist device reduces mortality for postcardiotomy failure: a three-center experience. — https://doi.org/10.1016/j.jtcvs.2003.09.055
[259] Efficacy and safety of post-closure technique using Perclose ProGlide/ProStyle device for large-bore mechanical circulatory support access sites. — https://doi.org/10.1016/j.carrev.2023.12.016
[267] Temporary ventricular assist device support with a catheter-based axial pump: Changing the paradigm at a pediatric heart center. — https://doi.org/10.1016/j.jtcvs.2022.11.039
[297] Gender disparities with the use of percutaneous left ventricular assist device in patients undergoing percutaneous coronary intervention complicated by cardiogenic shock: From pVAD Working Group — https://doi.org/10.1016/j.ihj.2018.04.009
[308] Phase‐Specific Hemodynamic Criteria and Outcomes in Patients With Cardiogenic Shock Receiving Percutaneous Ventricular Assist Devices — https://doi.org/10.1161/jaha.125.042249
[309] Outcomes of prolonged support on surgically implanted microaxial left ventricular assist devices for refractory cardiogenic shock — https://doi.org/10.1016/j.xjon.2025.03.023
[323] Clinical efficacy of direct or indirect left ventricular unloading during venoarterial extracorporeal membrane oxygenation for primary cardiogenic shock. — https://doi.org/10.1016/j.jtcvs.2021.06.024
[328] Outcomes of Veno-Arterial Extracorporeal Membrane Oxygenation With Percutaneous Left Ventricular Unloading in Fulminant Myocarditis — https://doi.org/10.1097/mat.0000000000002104
[334] Increased Plasma‐Free Hemoglobin Levels Identify Hemolysis in Patients With Cardiogenic Shock and a Trans valvular Micro‐Axial Flow Pump — https://doi.org/10.1111/aor.13319
[362] Central Venous Pressure and Clinical Outcomes During Left-Sided Mechanical Support for Acute Myocardial Infarction and Cardiogenic Shock — https://doi.org/10.3389/fcvm.2020.00155
[365] Impact of microaxillar mechanical left ventricular support on renal resistive index in patients with cardiogenic shock after myocardial infarction: a pilot trial to predict renal organ dysfunction in cardiogenic shock — https://doi.org/10.1177/2048872619860218
[373] Optimal antithrombotic regimen in patients with cardiogenic shock on ImpellaTM mechanical support: less might be more — https://doi.org/10.1093/ehjci/ehaa946.1843
[374] Percutaneous left ventricular assist support is associated with less pulmonary congestion and lower rate of pneumonia in patients with cardiogenic shock — https://doi.org/10.1136/openhrt-2020-001385
[381] Percutaneous Biventricular Mechanical Heart Support in Cardiogenic Shock: A Nursing Case Report — https://doi.org/10.4037/ccn2019477
[392] Clinical Outcomes Among Cardiogenic Shock Patients Supported with High-Capacity Impella Axial Flow Pumps: A Report from the Cardiogenic Shock Working Group. — https://doi.org/10.1016/j.healun.2024.05.015
[393] Prolonged Impella 5.5 Support in Patients with Cardiogenic Shock: A Single-Center Retrospective Analysis — https://doi.org/10.3390/jcm14165631
[394] Impella vs intra-aortic balloon pump in patients with acute myocardial infarction complicated with cardiogenic shock: an updated systematic review and meta-analysis — https://doi.org/10.4081/cardio.2025.61
[399] Usefulness of bicarbonate-based Impella purge solution in a patient with heparin-induced thrombocytopenia: the first case report of long-term management in Japan — https://doi.org/10.1007/s10047-024-01452-0
[406] The Successful Rotor Wing Transport of 2 Patients Requiring Biventricular Impella Support: A Case Series and Review. — https://doi.org/10.1016/j.amj.2023.07.010
[407] Mechanical life support algorithm for the emergency management of patients with left-sided Impella. — https://doi.org/10.5837/bjc.2023.024
[417] Trends in Veno‐Arterial Extracorporeal Life Support With and Without an Impella or Intra‐Aortic Balloon Pump for Cardiogenic Shock — https://doi.org/10.1161/jaha.121.025216
[420] Single‐access for Impella‐supported percutaneous coronary intervention using a sheathless technique with an 8 Fr guide — https://doi.org/10.1002/ccd.30427
[423] Hemolysis associated with Impella heart pump positioning: In vitro hemolysis testing and computational fluid dynamics modeling — https://doi.org/10.1177/0391398820909843
[424] The “TIDE”-Algorithm for the Weaning of Patients With Cardiogenic Shock and Temporarily Mechanical Left Ventricular Support With Impella Devices. A Cardiovascular Physiology-Based Approach — https://doi.org/10.3389/fcvm.2021.563484
[429] Role of acquired von Willebrand syndrome in the development of bleeding complications in patients treated with Impella RP devices — https://doi.org/10.1038/s41598-021-02833-8
[431] Cardiogenic Shock Complicating Acute Myocardial Infarction Treated With Percutaneous Coronary Intervention Supported by Impella: Implications of Advanced Age and Refractory Shock on Outcomes — https://doi.org/10.1097/cce.0000000000000447
[432] Predictors of Short-term Survival in Cardiogenic Shock Patients Requiring Left Ventricular Support Using the Impella CP or 5.0 — https://doi.org/10.1016/j.cjco.2021.03.008
[436] Mechanical circulatory support with the Impella 5.0 and the Impella Left Direct pumps for postcardiotomy cardiogenic shock at La Pitié-Salpêtrière Hospital. — https://doi.org/10.1093/ejcts/ezz179
[437] A Meta-Analysis Comparing Venoarterial (VA) Extracorporeal Membrane Oxygenation (ECMO) to Impella for Acute Right Ventricle Failure — https://doi.org/10.7759/cureus.19622
[439] Minimally invasive biventricular mechanical circulatory support with Impella pumps as a bridge to heart transplantation: a first‐in‐the‐world case report — https://doi.org/10.1002/ehf2.12412
[444] The use of a sentinel cerebral protection system during Impella CP removal in a patient with left ventricular thrombus — https://doi.org/10.1002/ccd.28956
[454] Mechanical circulatory support with extracorporeal membrane oxygenation and Impella 5.5 in patients with a postinfarction VSD: Combined or separate assist strategy? — https://doi.org/10.1111/jocs.15204
[464] Trends and outcomes of different mechanical circulatory support modalities for refractory cardiogenic shock in Takotsubo cardiomyopathy — https://doi.org/10.1016/j.ahjo.2025.100545
[466] Breast cancer surgery under mechanical circulatory support in a patient with cancer therapy-related cardiac dysfunction: a case report — https://doi.org/10.1093/ehjcr/ytaf407
[469] European practices on antithrombotic management during percutaneous mechanical circulatory support in adults: A survey of the Association for Acute CardioVascular Care (ACVC) of the ESC and the European branch of the Extracorporeal Life Support Organization (EuroELSO). — https://doi.org/10.1093/ehjacc/zuae040
[470] Early Utilization of Mechanical Circulatory Support in Acute Myocardial Infarction Complicated by Cardiogenic Shock: The National Cardiogenic Shock Initiative — https://doi.org/10.1161/jaha.123.031401
[471] Trends and outcomes of different mechanical circulatory support modalities for acute myocardial infarction associated cardiogenic shock in patients undergoing early revascularization — https://doi.org/10.1016/j.ahjo.2024.100468
[473] Efficacy and safety of percutaneous mechanical circulatory support in patients with cardiogenic shock following acute myocardial infarction: A meta-analysis of randomized controlled trials — https://doi.org/10.1097/md.0000000000040595
[508] Axillary Artery Access for Mechanical Circulatory Support Devices in Patients With Prohibitive Peripheral Arterial Disease Presenting With Cardiogenic Shock. — https://doi.org/10.1016/j.amjcard.2019.02.033
[514] Mechanical Circulatory Support to Treat Pulmonary Embolism: Venoarterial Extracorporeal Membrane Oxygenation and Right Ventricular Assist Devices. — https://doi.org/10.14503/thij-19-7025
