Anesthesia and Critical Care Reviews and Commentary (ACCRAC) Podcast Episode 320: Impella Update with Drs. Essandoh and Cody
Nov 2, 2025
Dr. Joseph Cody, a cardiac anesthesiologist passionate about medical education, and Dr. Michael Essandoh, an expert in cardiovascular anesthesia, dive into the latest on Impella technology. They explore critical guideline changes that elevate Impella's status in treating cardiogenic shock. Listeners learn about device placement techniques, management strategies, and the compelling results from key trials. They also discuss when to still consider IABP and share personal recommendations for lighthearted entertainment.
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Guideline Shift Away From IABP
- The 2025 ACC guidelines reclassified IABP as class III, indicating no survival benefit in AMI cardiogenic shock.
- This reflects a shift away from balloon pumps toward more effective mechanical support like Impella.
SCAI Staging And Cardiac Power
- The SCAI shock stages A–E stratify risk and guide escalation from medical therapy to mechanical support.
- Cardiac power output under 0.6 denotes profound shock and higher mortality risk.
Assess Hemodynamics Before Escalation
- Use echo and a PA catheter early to identify shock type and measure hemodynamics before choosing therapy.
- Escalate promptly if lactate rises or pulmonary edema worsens despite inotropes and vasopressors.
