To describe the implementation of a complication-prevention pathway for patients with cardiogenic shock receiving Impella support.
Approach:
Patient Population: 159 patients with cardiogenic shock who received Impella support at Kokura Memorial Hospital from July 2018 to April 2026.
Pathway Implementation: The pathway was introduced stepwise, focusing on standardizing safety practices across transitions of care.
Monitoring and Management: Systemic and lower-limb perfusion reassessment, limb ischemia management, hemolysis surveillance, and anticoagulation strategies were standardized.
Key Findings:
Bleeding Academic Research Consortium type 3 bleeding decreased from 35.6% to 11.1% across the three periods.
Detected hemolysis was more frequent during full implementation due to routine surveillance.
Thirty-day mortality decreased from 49.3% to 22.2% across the same periods.
Renal replacement therapy was used in 39 of 73 patients (53.4%), 20 of 50 patients (40.0%), and 12 of 36 patients (33.3%) across the three periods.
Interpretation:
The findings suggest that the safety of temporary mechanical circulatory support may depend on the surrounding care system as much as on the device itself.
Limitations:
The results are not proof of efficacy for Impella or the pathway.
Observations are vulnerable to changes over time and case-mix differences.
Conclusion:
A structured complication-prevention pathway may serve as a practical target for local quality improvement in centers using Impella for cardiogenic shock.
Moderate coffee consumption generally appeared safe for most adults, but randomized evidence suggested divergent effects on atrial fibrillation and premature ventricular contractions.
