Anesthetic Management in Patients with Impella Devices: A Retrospective Review and Clinical Guide

BACKGROUND: The Impella family of percutaneous a left ventricular assist devices are increasingly used for hemodynamic support in patients with cardiogenic shock or advanced heart failure. However, guidance on anesthetic management for patients with Impella support undergoing noncardiac procedures remains sparse. This study reviews perioperative practices and outcomes to inform clinical management. METHODS: Following institutional review board approval, a retrospective analysis was performed of adult patients receiving an Impella device (2.5, CP, 5.0, or 5.5) at Thomas Jefferson University Hospital, Philadelphia, USA, between December 2017 and October 2024. Patients, who subsequently underwent procedures involving anesthesia care were included. Demographics, procedure type, anesthetic technique, pharmacologic management, hemodynamic support, and intraoperative outcomes were analyzed descriptively. RESULTS: Among 165 Impella recipients, 41 underwent anesthesia requiring procedures: Eight gastrointestinal (GI) and 33 non-GI interventions. All GI cases involved Impella 5.5 devices, commonly for urgent endoscopy in gastrointestinal bleeding. General anesthesia was used in 50% of GI and 94% of non-GI cases. Propofol and etomidate were predominant induction agents; fentanyl and rocuronium were widely utilized. Phenylephrine and norepinephrine were the most frequent vasopressors, with adjunctive use of dobutamine or epinephrine. No intraoperative device malfunctions, dislodgements, or arrests occurred. CONCLUSIONS: With individualized anesthetic planning and vigilant hemodynamic control, Impella-supported patients can safely undergo diverse procedures. Deep sedation may suffice for select endoscopic interventions, whereas complex non-GI operations generally require general anesthesia. These findings provide a foundation for developing standardized perioperative management protocols for this growing patient population.