Impact of Impella 5.5 duration support and clinical outcomes in cardiogenic shock: Evidence from a systematic review and meta-analysis of observational studies.

BACKGROUND

The Impella 5.5 is FDA-approved for up to 14 days of support in patients with cardiogenic shock, however, its extended use is increasingly employed as a bridge to advanced therapies.

AIM: To compare outcomes with short-term (≤14 days) vs prolonged (>14 days) Impella 5.5 support in patients with cardiogenic shock.

METHODS

Multiple databases were searched through September 2025 to identify relevant studies, and 5 studies met the inclusion criteria, encompassing total of 1,440 patients. Pooled risk ratios (RRs) with 95% confidence intervals (CI) were calculated using a random-effects meta-analysis in R-software.

RESULTS

Prolonged Impella 5.5 support (>14 days) was associated with a higher likelihood of successful bridging to heart transplantation (RR: 1.96, 95% CI: 1.01-3.83; p = 0.049), and with lower in-hospital mortality rate (RR: 0.67, 95% CI: 0.53-0.84; p = 0.011). However, native heart survival or recovery (RR: 0.70, 95% CI: 0.54-0.90; p = 0.026) was significantly lower with prolonged support. There was no significant difference in bridging to durable LVAD between the groups (RR: 0.86; 95% CI: 0.54-1.36, p = 0.28). Prolonged Impella support was associated with higher risks of insertion-site hematoma (RR: 1.55, 95% CI: 1.07-2.24; p = 0.036) and infection (RR: 3.36, 95% CI: 2.71-4.17; p = 0.002), while stroke rates were similar between groups (RR: 1.34; 95% CI: 0.96-1.89; p = 0.074).

CONCLUSIONS

Extending Impella 5.5 support beyond 14 days in patients with cardiogenic shock appears advantageous for select patients, conferring improved survival and higher likelihood of successful bridging to heart transplantation. However, significantly higher risk of implant-site hematoma and infection necessitates meticulous vascular management, infection-prevention strategies and close clinical surveillance.