Clinical outcomes following Impella escalation in cardiogenic shock: a single-centre case series highlighting the gap between haemodynamic improvement and survival

The use of temporary mechanical circulatory support has increased in patients with cardiogenic shock, particularly those with acute myocardial infarction (AMI). Impella provides effective left ventricular unloading and haemodynamic stabilisation. Escalation of such systems to higher-flow devices (e.g., Impella 5.0/5.5) has been proposed for patients with inadequate responses to Impella CP; however, the clinical impact and optimal timing of this approach remain unclear.