Biventricular Compared to Left Ventricular Impella and Norepinephrine Support in a Porcine Model of Severe Cardiogenic Shock

Nanna L J Udesen, Jakob Josiassen, Ole K L Helgestad, Ann B S Banke, Peter H Frederiksen, Lisette O Jensen, Henrik Schmidt, Hanne B Ravn, Jacob E Møller


Contemporary management of cardiogenic shock (CS) with vasopressors is associated with increased cardiac workload and despite the use of unloading devices such as the Impella pump, concomitant vasopressors are often necessary. Therefore, we compared if cardiac workload could be reduced and end-organ perfusion preserved with biventricular support (Bipella) compared to ImpellaCP and norepinephrine in pigs with left ventricular (LV) CS caused by left main coronary microembolization. Cardiac workload was calculated from heart rate × ventricular pressure-volume area obtained from conductance catheters placed in the LV and right ventricle (RV), whereas organ perfusion was measured from venous oxygen saturation in the pulmonary artery (SvO2) and the kidney- and the cerebral vein. A cross-over design was used to access the difference after 30 minutes of ImpellaCP and norepinephrine 0.1 µg/kg/min versus Bipella for 60 minutes. Bipella treatment reduced LV workload (p = 0.0078) without significant difference in RV workload from ImpellaCP and norepinephrine, however a decrease in SvO2 (49[44-58] vs. 66[63-73]%, p = 0.01) and cerebral venous oxygen saturations (62[48-66] vs. 71[63-77]%, p = 0.016) was observed during Bipella compared to ImpellaCP and norepinephrine. We conclude that Bipella reduced LV workload but did not preserve end-organ perfusion compared to ImpellaCP and norepinephrine in short-term LV CS.

Original languageEnglish
JournalASAIO journal (American Society for Artificial Internal Organs : 1992)
Issue number9
Pages (from-to)1141-1148
Number of pages8
Publication statusPublished - 1 Sep 2022


  • Animals
  • Cross-Over Studies
  • Heart Ventricles
  • Heart-Assist Devices
  • Norepinephrine/therapeutic use
  • Shock, Cardiogenic/therapy
  • Swine
  • Vasoconstrictor Agents
  • Impella
  • experimental study
  • mechanical circulatory support
  • cardiogenic shock
  • pressure-volume area
  • organ perfusion
  • vasopressors
  • cardiac work


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