Multi-institutional outcomes of Impella use in pediatric patients: A brief communication from the ACTION Network.

This retrospective cohort study includes 150 pediatric patients supported with the Impella between April 2018 and November 2024. Median weight was 62.9 kg (interquartile range [IQR] 51.0-79.7 kg) and the smallest weighed 19.0 kg. Axillary artery implants occurred in 40.1% of patients while the femoral artery was used in 29%. Most patients had dilated cardiomyopathy (57.3%); however, a significant portion had transplant graft dysfunction (14.7%) or congenital heart disease (13.3%). One quarter of the cohort (N = 38) were supported with extracorporeal membrane oxygenation (ECMO) before Impella; 76% (N = 29) used ECMO and Impella in tandem, while 24% (N = 9) transitioned from ECMO to Impella. Major bleeding, major infection, device malfunction, or stroke were reported in 28% of patients (N = 42). Positive clinical outcomes were achieved in 89.3% of patients; 32.7% explanted for recovery, 32% transplanted, and 23.3% changed to another device. These data demonstrate a potential role for this device in children with refractory advanced heart failure and a need for increased work to limit adverse events.