UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support.
Abstract
The use of left-sided Impella microaxial flow pumps has expanded rapidly for the management of cardiogenic shock, left ventricular unloading and as a bridge to heart transplantation. However, standard life support and resuscitation algorithms are not directly applicable to patients receiving this therapy due to fundamental alterations in circulatory physiology. To address this gap, eleven UK Impella centres and eight national professional societies collaborated to develop a unified national consensus statement on the emergency management of patients with left-sided Impella support. Using a systematic review of the literature and a modified Delphi process guided by the European Society of Cardiology framework for grading recommendations, expert representatives achieved agreement on key priorities and structured actions to be undertaken in the first few minutes of resuscitation.The consensus outlines early recognition of circulatory inadequacy (mean arterial pressure <30 mm Hg or end-tidal CO₂ <2 kPa), prompt activation of multidisciplinary responders, reduction of Impella power to P2 before initiating cardiopulmonary resuscitation and structured division of patient-focused and device-focused teams. Device-specific troubleshooting algorithms are presented for suction, malposition, purge-system failure and mechanical malfunction. This multisociety consensus represents the first national standard for emergency management and resuscitation of patients supported by a left-sided Impella device and is intended to inform structured clinical training and improve patient outcomes through rapid, coordinated and physiologically tailored interventions.
Author
Akhtar, Waqas
Bowles, Christopher T
Costanzo, Pierluigi
Deakin, Charles D
Elliot, Pauline
Eladawy, Mostafa
Gardner, Roy S
Govier, Matthew
Handslip, Rhodri
Hill, Jonathan
Jain, Ajay
Khan, Sohail Q
Lewis, Ifan
Lim, Hoong Sern
Mariathas, Mark
Mellis, Clare
Monteagudo-Vela, Maria
Naldrett, Ian
Ostermann, Marlies
Perera, Divaka
Pinto, Sofia
Richardson, Carla
Ranasinghe, Aaron
Gil, Fernando Riesgo
Rosenberg, Alex
Schueler, Stephan
Sinclair, Andrew
Swanson, Neil
Wilson, Simon
Webb, Ian
Webb, Stephen
Walker, Christopher
Panoulas, Vasileios
Bowles, Christopher T
Costanzo, Pierluigi
Deakin, Charles D
Elliot, Pauline
Eladawy, Mostafa
Gardner, Roy S
Govier, Matthew
Handslip, Rhodri
Hill, Jonathan
Jain, Ajay
Khan, Sohail Q
Lewis, Ifan
Lim, Hoong Sern
Mariathas, Mark
Mellis, Clare
Monteagudo-Vela, Maria
Naldrett, Ian
Ostermann, Marlies
Perera, Divaka
Pinto, Sofia
Richardson, Carla
Ranasinghe, Aaron
Gil, Fernando Riesgo
Rosenberg, Alex
Schueler, Stephan
Sinclair, Andrew
Swanson, Neil
Wilson, Simon
Webb, Ian
Webb, Stephen
Walker, Christopher
Panoulas, Vasileios
Date
2025-12-18
Type
Article
Subject
Cardiology, Resuscitation
Collections
Citation
Akhtar W, Bowles CT, Costanzo P, Deakin CD, Elliot P, Eladawy M, Gardner RS, Govier M, Handslip R, Hill J, Jain A, Khan SQ, Lewis I, Lim HS, Mariathas M, Mellis C, Monteagudo-Vela M, Naldrett I, Ostermann M, Perera D, Pinto S, Richardson C, Ranasinghe A, Gil FR, Rosenberg A, Schueler S, Sinclair A, Swanson N, Wilson S, Webb I, Webb S, Walker C, Panoulas V. UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support. Heart. 2025 Dec 18:heartjnl-2025-326896. doi: 10.1136/heartjnl-2025-326896.
Journal / Source Title
Heart
DOI
10.1136/heartjnl-2025-326896
PMID
41412762
Publisher
BMJ Pub. Group
Publisher’s URL
https://pubmed.ncbi.nlm.nih.gov/41412762/