Hemodynamic improvement with Impella RP in acute massive pulmonary embolism: a narrative review of cardiovascular outcomes and pulmonary catheter pressure assessment

Background: Acute massive pulmonary embolism (PE) can lead to right ventricular (RV) failure and cardiogenic shock, requiring urgent treatment. Thrombolytic therapy is the standard treatment for high-risk PE in hemodynamically unstable patients. However, in cases where thrombolytics are contraindicated or ineffective, mechanical circulatory support (MCS) serves as a rescue therapy. While veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is commonly utilized, the Impella RP represents a promising advancement in MCS, offering right ventricular support in patients with PE-induced cardiogenic shock. Objective: This narrative review evaluates the role of the Impella RP in improving hemodynamic parameters in patients with PE-induced cardiogenic shock or right ventricular failure. By reviewing available case reports and case series, we assess the effectiveness of Impella RP in improving patient outcomes. Methods: A comprehensive literature review was conducted, obtaining data from clinical studies, case reports, case series, systematic review, and hemodynamic assessments of Impella RP in massive PE. Key parameters, including blood pressure (BP), heart rate (HR), right atrial pressure (RAP), pulmonary artery pressure (PAP), cardiac index (CI), cardiac output (CO), and overall patient outcomes, were analyzed before and after device implantation. Findings: Our review identified 10 patients from case reports and case series in which the Impella RP was used as mechanical circulatory support (MCS) in high-risk PE patients. Hemodynamic parameters showed significant improvement following Impella RP implantation. Notably the survival rate was 100%, highlighting the role of Impella RP in managing massive PE with right ventricular failure. Conclusion: The use of Impella RP in hemodynamically unstable patients with high risk PE have shown positive outcome, including improved cardiac function and hemodynamic stability. These findings suggest that Impella RP could be valuable treatment options for patients with massive PE and right heart failure. However, the limited number of reported cases highlights the need for larger-scale clinical studies and randomized trials to further assess the long-term safety, efficacy, and optimal patient selection criteria for Impella RP use.