{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T19:32:19Z","timestamp":1786649539602,"version":"build-2736575974"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,4,1]],"date-time":"2026-04-01T00:00:00Z","timestamp":1775001600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>The Impella family of percutaneous a left ventricular assist devices are increasingly used for hemodynamic support in patients with cardiogenic shock or advanced heart failure. However, guidance on anesthetic management for patients with Impella support undergoing noncardiac procedures remains sparse. This study reviews perioperative practices and outcomes to inform clinical management.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Following institutional review board approval, a retrospective analysis was performed of adult patients receiving an Impella device (2.5, CP, 5.0, or 5.5) at Thomas Jefferson University Hospital, Philadelphia, USA, between December 2017 and October 2024. Patients, who subsequently underwent procedures involving anesthesia care were included. Demographics, procedure type, anesthetic technique, pharmacologic management, hemodynamic support, and intraoperative outcomes were analyzed descriptively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Among 165 Impella recipients, 41 underwent anesthesia requiring procedures: Eight gastrointestinal (GI) and 33 non-GI interventions. All GI cases involved Impella 5.5 devices, commonly for urgent endoscopy in gastrointestinal bleeding. General anesthesia was used in 50% of GI and 94% of non-GI cases. Propofol and etomidate were predominant induction agents; fentanyl and rocuronium were widely utilized. Phenylephrine and norepinephrine were the most frequent vasopressors, with adjunctive use of dobutamine or epinephrine. No intraoperative device malfunctions, dislodgements, or arrests occurred.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>With individualized anesthetic planning and vigilant hemodynamic control, Impella-supported patients can safely undergo diverse procedures. Deep sedation may suffice for select endoscopic interventions, whereas complex non-GI operations generally require general anesthesia. These findings provide a foundation for developing standardized perioperative management protocols for this growing patient population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/aca.aca_308_25","type":"journal-article","created":{"date-parts":[[2026,4,14]],"date-time":"2026-04-14T13:00:22Z","timestamp":1776171622000},"page":"237-246","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Anesthetic Management in Patients with Impella Devices: A Retrospective Review and Clinical Guide"],"prefix":"10.4103","volume":"29","author":[{"given":"Harrison","family":"Yang","sequence":"first","affiliation":[{"name":"Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Divakara","family":"Gouda","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Inspira Health Network, Mullica Hill, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kent B.","family":"Berg","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Perioperative Medicine, Thomas Jefferson University, Philadelphia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katherine","family":"Green","sequence":"additional","affiliation":[{"name":"The Johns Hopkins University, Baltimore, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Suvan","family":"Sundaresh","sequence":"additional","affiliation":[{"name":"Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Basavana","family":"Goudra","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, United States"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,4,15]]},"reference":[{"key":"R1-20260415","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1111\/joic.12080","article-title":"The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: Results from the USpella registry","volume":"27","author":"O'Neill","year":"2014","journal-title":"J Intervent Cardiol"},{"key":"R2-20260415","doi-asserted-by":"crossref","first-page":"287","DOI":"10.3949\/ccjm.84gr.17002","article-title":"Cardiogenic shock: From ECMO to Impella and beyond","volume":"84","author":"Shishehbor","year":"2017","journal-title":"Cleve Clin J Med"},{"key":"R3-20260415","doi-asserted-by":"crossref","first-page":"1087","DOI":"10.1080\/17434440.2024.2436122","article-title":"A profile of the impella 5.5 for the clinical management of cardiogenic shock and a review of the current indications for use and future directions","volume":"21","author":"Hershenhouse","year":"2024","journal-title":"Expert Rev Med Devices"},{"key":"R4-20260415","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1186\/s13054-016-1328-z","article-title":"Mechanical circulatory assist devices: A primer for critical care and emergency physicians","volume":"20","author":"Sen","year":"2016","journal-title":"Crit Care"},{"key":"R5-20260415","doi-asserted-by":"crossref","first-page":"404","DOI":"10.1002\/ejhf.668","article-title":"Concomitant implantation of Impella\u00ae on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock","volume":"19","author":"Pappalardo","year":"2017","journal-title":"Eur J Heart Fail"},{"key":"R6-20260415","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1186\/s40981-020-00324-9","article-title":"Pitfalls of anesthetic management with the Impella\u00ae5.0 device: A case series","volume":"6","author":"Hotta","year":"2020","journal-title":"JA Clin Rep"},{"key":"R7-20260415","doi-asserted-by":"crossref","first-page":"e05","DOI":"10.15420\/icr.2021.11","article-title":"A review of the Impella devices","volume":"17","author":"Zein","year":"2022","journal-title":"Interv Cardiol Lond Engl"},{"key":"R8-20260415","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1186\/s13019-022-01871-1","article-title":"Single center first year experience and outcomes with Impella 5.5 left ventricular assist device","volume":"17","author":"Rock","year":"2022","journal-title":"J Cardiothorac Surg"},{"key":"R9-20260415","doi-asserted-by":"crossref","first-page":"100067","DOI":"10.1016\/j.ahjo.2021.100067","article-title":"Outcomes of Impella compared with intra-aortic balloon pump in ST-elevation myocardial infarction complicated by cardiogenic shock","volume":"12","author":"Thakkar","year":"2021","journal-title":"Am Heart J Plus Cardiol Res Pract"},{"key":"R11-20260415","doi-asserted-by":"crossref","first-page":"250","DOI":"10.4103\/0971-9784.119167","article-title":"Anesthesia for gastrointestinal endoscopy in patients with left ventricular assist devices: Initial experience with 68 procedures","volume":"16","author":"Goudra","year":"2013","journal-title":"Ann Card Anaesth"},{"key":"R12-20260415","doi-asserted-by":"crossref","first-page":"1301538","DOI":"10.3389\/fcvm.2024.1301538","article-title":"Case report: Abdominal surgery with the support of Impella (surgella), a new frontier to be explored","volume":"11","author":"Guarracini","year":"2024","journal-title":"Front Cardiovasc Med"}],"container-title":["Annals of Cardiac Anaesthesia"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_308_25","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,13]],"date-time":"2026-08-13T18:55:11Z","timestamp":1786647311000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/aca.aca_308_25"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4]]},"references-count":11,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2026]]}},"URL":"https:\/\/doi.org\/10.4103\/aca.aca_308_25","relation":{},"ISSN":["0971-9784","0974-5181"],"issn-type":[{"value":"0971-9784","type":"print"},{"value":"0974-5181","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4]]},"assertion":[{"value":"2025-10-17","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-12-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}