key: cord-0756156-8sbxrkun
authors: Mahrokhian, Shant H.; Nordan, Taylor; Ortoleva, Jamel P.; Cobey, Frederick C.; Chen, Frederick Y.; Kapur, Navin K.; Kawabori, Masashi
title: Successful use of Impella 5.5 to manage cardiogenic shock complicated by COVID‐19
date: 2021-10-01
journal: J Card Surg
DOI: 10.1111/jocs.16038
sha: 738836fedd5a152c71b3ba72fb20d4c6206eac8c
doc_id: 756156
cord_uid: 8sbxrkun

Background: Acute decompensated heart failure in patients with coronavirus disease 2019 (COVID‐19) is becoming increasingly common. Aims: In this case report, we describe the successful use of an Impella 5.5 (Abiomed) to treat cardiogenic shock refractory to inotropic therapy. Materials & Methods: Transthoracic and transesophageal echocardiography confirmed severely diminished left ventricular ejection fraction and a reverse‐transcription polymerase chain reaction test revealed that the patient was COVID‐19 positive during his hospital admission. Results: Following initiation of inotropic therapy, we placed an Impella 5.5 for further cardiac support. The patient's LVEF and cardiac index improved after 21 days on the Impella 5.5 and was maintained following explant. Discussion & Conclusion: The findings reported here demonstrate successful use of an Impella 5.5 to improve native heart function in refractory cardiogenic shock and further indicate its use as an option for those in acute decompensated heart failure who have tested positive for COVID‐19 infection.

Coronavirus disease 2019 (COVID-19) has spread globally, establishing widespread prevalence in under one year. As cases continue to rise among the unvaccinated population in the United States, there will likely be increases in the number of patients presenting with primary organ dysfunction in the setting of infection or following resolution of disease. One case series recently demonstrated that the use of a durable left ventricular assist device (LVAD) in patients with COVID-19 led to similar survival outcomes as non-LVAD patients with COVID-19 aged 70-79 years old. 1 Although several case reports have described the successful use of Impella 5.0 in COVID-19 positive patients, [2] [3] [4] to the best of our knowledge, the same findings with Impella 5.5 have only been described by the device manufacturer. Herein, we report successful Impella 5.5 use on a COVID-19 positive patient in cardiogenic shock (CS) refractory to inotropic therapy. LVEF of 35% (Supporting Information Video). On Day 23, 2 days after Impella 5.5 explant, LVEF further improved to 40%.

In the context of CS refractory to inotropic therapy, unloading the LV with MCS can improve native heart function. [5] [6] [7] Here, we report on a 65-year-old male with profound CS whose heart function improved with Impella 5.5 support. COVID-19 infection was initially managed with Remdesivir but discontinued due to acute kidney injury. He was subsequently started on dexamethasone, recently shown to reduce 28-day mortality among patients hospitalized with COVID-19. 8 With COVID-19 on the rise among the unvaccinated, the threat to patients with heart failure becomes increasingly concerning. A retrospective cohort study by Bhatt et al. 9 revealed that one in four patients with heart failure hospitalized for COVID-19 died in-hospital. 9 However, the underlying mechanisms associating COVID-19 positivity to cardiovascular morbidity remain poorly understood. One explanation for myocardial injury is through direct entry and proliferation of virus in the myocardium, 10 

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Successful use of Impella 5.5 to manage cardiogenic shock complicated by COVID-19