June 1, 2020 — The U.S. Food and Drug Administration (FDA) has issued an emergency use authorization (EUA) for the Abiomed Impella RP catheter-based heart pump to include patients suffering from COVID-19 related right heart failure or decompensation, including pulmonary embolism (PE).
Impella RP is a temporary heart pump that provides circulatory hemodyamic support for patients who develop right side ventricular failure. Five years of pre- and post-market clinical studies support Impella RP’s safety and efficacy. In 2017, Impella RP received FDA approval as safe and effective for treating right ventricular failure in the setting of acute myocardial infarction and after cardiac surgery. Biventricular cardiac support can be provided when Impella RP is used in combination with left-side Impella devices.
Since the onset of the COVID-19 pandemic, Impella RP has been used to treat certain COVID-19 patients suffering right heart failure. COVID-19 can create a prothrombotic environment in some patients resulting in acute pulmonary, embolism which may lead to acute right ventricular failure. For critically ill patients the Impella RP can be rapidly deployed in a matter of minutes using a minimally invasive technique in the cardiac cath lab or operating room.
In its authorization letter, the FDA writes, “Based on extrapolation of data from the approved indication and reported clinical experience, FDA has concluded that the Impella RP may be effective at providing temporary right ventricular support for the treatment of acute right heart failure or decompensation caused by COVID-19 complications, including PE.”
“Acute pulmonary embolism is clearly being recognized as a life-threatening manifestation of COVID-19. Impella RP is an important tool to help cardiologists save lives during this pandemic. As we have demonstrated in our series of patients, early recognition of right ventricular dysfunction and early placement of the Impella RP for patients who are hypotensive can be life-saving,” said Amir Kaki, M.D., an interventional cardiologist and director of mechanical circulatory support at Ascension St. John Hospital in Detroit.
For example, a 59-year-old Detroit-area woman diagnosed with COVID-19 benefited from Impella RP therapy. Kaki and his colleague, Ted Schreiber, M.D., diagnosed her with an acute pulmonary embolism. After the clot was removed, the patient went into right ventricular failure and became hypotensive.
Schreiber and Kaki quickly placed an Impella RP and observed what they describe as a “dramatic and immediate” improvement in arterial pressure. Over the next five days, the Impella RP remained in place and the patient was monitored remotely using cloud-based Impella Connect technology. On the fifth day, Impella RP was removed. The patient was later discharged home with her native heart. This case has been highlighted in the American College of Cardiology (ACC) educational programming on COVID-19 and can be reviewed online.
“This patient demonstrated a profound recovery after placement of Impella RP,” said Schreiber, who is chief of cardiology at Ascension St. John Macomb-Oakland Hospital and senior author of a 2018 academic review of pulmonary embolism patients treated with Impella RP. “In the course of 30 seconds, there was a dramatic and immediate hemodynamic response and the patient’s blood pressure markedly improved. This case demonstrates the efficacy and robustness of Impella RP in the setting of right ventricular failure.”
Published academic research presented to the FDA that demonstrates the feasibility of Impella RP to improve right ventricular function in patients with pulmonary embolism includes:
• Zuin, et al., Europe PMC, 2019 – This review of the treatment of pulmonary embolism using Impella RP concludes, “reviewed manuscripts demonstrated a significant hemodynamic improvement with a concomitant reduction of the right ventricle after load in all patients which exhibit a low mortality rate in the short-term period.”
• Elder, et al., Journal of Interventional Cardiology, 2018 – This study, reviewing the largest experience of pulmonary embolism patients treated with Impella RP concludes, use of Impella RP in patients with pulmonary embolism and right ventricular failure might improve hemodynamics and facilitate a bridge-to-recovery.
• Bhatia, et al, Catherization and Cardiovascular Interventions, 2017 – A case review of a 47-year-old man with a massive pulmonary embolism supported with Impella RP for 48 hours. Impella support resulted in immediate increase in mean arterial pressure and decreased vasopressor requirements. The patient was discharged in one week.
FDA PMA Indication for the Impella RP
The Impella RP System is indicated for providing temporary right ventricular support for up to 14 days in patients with a body surface area ≥1.5 m2, who develop acute right heart failure or decompensation following left ventricular assist device implantation, myocardial infarction, heart transplant, or open-heart surgery.
Emergency Use Authorization for Impella RP
The Impella RP System is authorized to be used by healthcare providers (HCP) in the hospital setting for providing temporary right ventricular support for up to 14 days in critical care patients with a body surface area ≥1.5 m2, for the treatment of acute right heart failure or decompensation caused by complications related to Coronavirus Disease 2019 (COVID-19), including pulmonary embolism (PE).
Related COVID-19 Hemodynamic Support Content:
VIDEO: Multiple Cardiovascular Presentations of COVID-19 in New York — Interview with Justin Fried, M.D., explaining a case that used VV-ECMO abnd VAV-ECMO
VIDEO: Impact of COVID-19 on the Interventional Cardiology Program at Henry Ford Hospital — Interview with William O'Neill, M.D.