Although the Impella has been approved for years, no randomised study data exist. In 2008, the ISAR-SHOCK trial randomised patients in cardiogenic shock to Impella 2.5 (n = 12) support or to intra-aortic balloon pump (IABP) (n = 13) support over 28 months in only two hospitals. There was no difference in mortality at 30 days – 46% in each group [
1]. A recent meta-analysis by Wernly et al. suggested that the Impella was not associated with improved survival but with a higher rate of vascular complications compared with IABP or medical therapy [
2]. Recently, O’Neill et al published the outcomes of 15,259 patients with acute myocardial infarction and secondary cardiogenic shock supported with Impella (US registry of cardiogenic shock with Impella). The survival improved from 52 to 59%with the use of Impella CP
® before percutaneous coronary intervention as compared with IABP and vasopressors (p <0.001) [
3]. It is clear that the scientific literature lacks robust data regarding this pathology.