Impella Support as a “Bridge to Nowhere”　― Ethical and Clinical Considerations for End-of-Life Care After Acute Myocardial Infarction ―

Background: Impella and other percutaneous mechanical circulatory support (MCS) devices are increasingly used for cardiogenic shock complicating acute myocardial infarction. Although they provide rapid hemodynamic stabilization, some patients do not achieve myocardial recovery and are not candidates for heart transplantation or durable MCS. In such situations, Impella may become a “bridge to nowhere”, raising ethical and clinical questions about continuation or withdrawal.