Computational Evaluation of IABP, Impella 2.5, TandemHeart and Combined IABP and Impella 2.5 Support in Cardiogenic Shock

Abstract

Cardiogenic shock is a life-threatening condition consisting of low cardiac output status leading to end-organ hypoperfusion following either acute left or right ventricular failure or decompensation of chronic heart failure. Partial or failed response to inotropic support in the acute phase may require the use of mechanical circulatory support. Although patients supported with different devices such as an IABP, Impella 2.5, or TandemHeart experience stability in the short term, the haemodynamic benefits of each device remain unclear. The aim of this study is to present a direct comparison of an IABP, Impella 2.5, TandemHeart, and combined IABP and Impella 2.5 support in cardiogenic shock to evaluate haemodynamic variables and left ventricular unloading using cardiovascular system modelling and simulation in terms of cardiac function, systemic, pulmonary, cardiac, and cerebral circulations. The simulation results showed that the IABP had a relatively low effect on the haemodynamic variables. Although both Impella 2.5 and TandemHeart improved the total blood flow rates, as well as coronary and cerebral perfusion with the increasing pump operating speed, TandemHeart had a more profound effect on the haemodynamic variables. Combining the IABP and Impella 2.5 also improved the haemodynamics, although at the expense of reverse blood flow in the cerebral circulation. Simulation results showed that TandemHeart support might have a more beneficial effect on the haemodynamics and left ventricular energetics in comparison to the IABP and Impella 2.5. Nevertheless, the combined use of the IABP and Impella 2.5 for short-term support may be considered an appropriate alternative.