UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support

The use of left-sided Impella microaxial flow pumps has expanded rapidly for the management of cardiogenic shock, left ventricular unloading and as a bridge to heart transplantation. However, standard life support and resuscitation algorithms are not directly applicable to patients receiving this therapy due to fundamental alterations in circulatory physiology. To address this gap, eleven UK Impella centres and eight national professional societies collaborated to develop a unified national consensus statement on the emergency management of patients with left-sided Impella support. Using a systematic review of the literature and a modified Delphi process guided by the European Society of Cardiology framework for grading recommendations, expert representatives achieved agreement on key priorities and structured actions to be undertaken in the first few minutes of resuscitation.The consensus outlines early recognition of circulatory inadequacy (mean arterial pressure <30 mm Hg or end-tidal CO₂ <2 kPa), prompt activation of multidisciplinary responders, reduction of Impella power to P2 before initiating cardiopulmonary resuscitation and structured division of patient-focused and device-focused teams. Device-specific troubleshooting algorithms are presented for suction, malposition, purge-system failure and mechanical malfunction. This multisociety consensus represents the first national standard for emergency management and resuscitation of patients supported by a left-sided Impella device and is intended to inform structured clinical training and improve patient outcomes through rapid, coordinated and physiologically tailored interventions.

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Publication Details

Journal
Heart
Published
2025-12-18
DOI
https://doi.org/10.1136/heartjnl-2025-326896
Primary Topic
Mechanical Circulatory Support Devices
Type
article
Field-Weighted Citation Impact
0.00

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article

UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support

Neil A. Swanson, Carla Richardson, Clare Mellis, Pierluigi Costanzo et al.
Heart
Mechanical Circulatory Support Devices
article

UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support

Neil A. Swanson, Carla Richardson, Clare Mellis, Pierluigi Costanzo, Christopher J. Walker, Fernando Riesgo-Gil, Christopher Bowles, Ian Naldrett, Vasileios F. Panoulas, Roy S. Gardner, Stephen Webb, Divaka Perera, Matthew Govier, Jonathon T. Hill, María Monteagudo‐Vela, Sohail Q. Khan, Marlies Ostermann, Ian Lewis, Hoong Sern Lim, Mark Mariathas, Simon Wilson, Rhodri Handslip, Charles D. Deakin, Waqas Akhtar, Aaron M. Ranasinghe, Sofia Pinto, Ajay K. Jain, Perry M Elliot, Alex Rosenberg, Mostafa Eladawy, Andrew Sinclair, Ian Webb, Stephan Schueler
article en

Abstract

The use of left-sided Impella microaxial flow pumps has expanded rapidly for the management of cardiogenic shock, left ventricular unloading and as a bridge to heart transplantation. However, standard life support and resuscitation algorithms are not directly applicable to patients receiving this therapy due to fundamental alterations in circulatory physiology. To address this gap, eleven UK Impella centres and eight national professional societies collaborated to develop a unified national consensus statement on the emergency management of patients with left-sided Impella support. Using a systematic review of the literature and a modified Delphi process guided by the European Society of Cardiology framework for grading recommendations, expert representatives achieved agreement on key priorities and structured actions to be undertaken in the first few minutes of resuscitation.The consensus outlines early recognition of circulatory inadequacy (mean arterial pressure <30 mm Hg or end-tidal CO₂ <2 kPa), prompt activation of multidisciplinary responders, reduction of Impella power to P2 before initiating cardiopulmonary resuscitation and structured division of patient-focused and device-focused teams. Device-specific troubleshooting algorithms are presented for suction, malposition, purge-system failure and mechanical malfunction. This multisociety consensus represents the first national standard for emergency management and resuscitation of patients supported by a left-sided Impella device and is intended to inform structured clinical training and improve patient outcomes through rapid, coordinated and physiologically tailored interventions.

Heart
University Hospitals Birmingham NHS Foundation Trust (GB), St Thomas' Hospital (GB), Guy's and St Thomas' NHS Foundation Trust (GB), Barts Health NHS Trust (GB), Royal Papworth Hospital (GB), University Hospital of Wales (GB), Freeman Hospital (GB), Golden Jubilee National Hospital (GB), Harefield Hospital (GB), Bristol Royal Infirmary (GB), Faculty (United Kingdom) (GB), Royal Brompton Hospital (GB), Intensive Care Society (GB), King's College Hospital NHS Foundation Trust (GB), St George's Hospital (GB), British Cardiovascular Society (GB), Association of British Paediatric Nurses (GB), Society for Cardiothoracic Surgery in Great Britain & Ireland (GB), Resuscitation Council (GB)
Pfizer, Alnylam Pharmaceuticals, Edwards Lifesciences, Boston Scientific Corporation, Abiomed
Openalex Percentile: Top 60%
Mechanical Circulatory Support Devices
DOIOpen Access PDFOpenAlex
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