Internal Medicine resident Northwell Health, North Shore University Hospital and Long Island Jewish Medical Center Takoma Park, Maryland, United States
Disclosure(s):
Quynh Le, MD: No financial relationships to disclose
Background: As Impella use has increased in the management of cardiogenic shock, confirming optimal device positioning is critical for effective support and minimizing complications. Although transthoracic echocardiography (TTE) is frequently used to assess device position after implantation, the utility of early routine TTEs in the absence of clinical change remains uncertain.
Methods: Adult patients receiving Impella support (CP, 5.0, or 5.5) between 2016 and 2022 at six Northwell Health hospitals were retrospectively reviewed. Patients without TTEs performed within 72 hours of implantation were excluded. All TTEs obtained within 72 hours of post-implantation were analyzed and classified as routine studies if performed in the absence of documented clinical indications (hemodynamic instability, bleeding, arrhythmia, worsening hypoperfusion markers) or device alarms. Impella repositioning was defined by documented adjustment in TTE reports or same-day clinical notes, or by a change in device position on serial TTEs. Multivariable regression was used to assess associations between repositioning and in-hospital adverse outcomes and mortality.
Outcome: A total of 321 TTEs were performed in 153 patients within 72 hours following Impella implantation. Of these, 228 TTEs (71%) from 100 patients were classified as routine studies. Among routine TTEs, 43 (19%) led to device repositioning in 33 patients. Patients requiring repositioning had a higher median number of TTEs compared to those who did not (3 vs. 2; p< 0.01). After multivariable adjustment, device repositioning prompted by routine TTEs was not associated with a reduction in in-hospital adverse events, including major bleeding, thrombotic events, sepsis, initiation of dialysis, escalation to extracorporeal membrane oxygenation (ECMO), and in-hospital mortality.
Conclusion: In this multicenter retrospective study, 71% of TTEs performed after Impella implantation were routine. Although 19% of routine TTEs prompted repositioning, these interventions were not associated with improved clinical outcomes. Consequently, early routine TTEs demonstrated limited utility without clinical indications. Given the small cohort, larger studies are warranted.
