18 Dec 2025
The first national emergency algorithm for the management of patients with Impella generated by eight national societies and eleven of the highest volume centres in the UK
The use of left-sided Impella microaxial flow pumps has expanded rapidly for the management of cardiogenic shock, left ventricular unloading and as a bridge to heart transplantation. However, standard life support and resuscitation algorithms are not directly applicable to patients receiving this therapy due to fundamental alterations in circulatory physiology. To address this gap, eleven UK Impella centres and eight national professional societies collaborated to develop a unified national consensus statement on the emergency management of patients with left-sided Impella support. Using a systematic review of the literature and a modified Delphi process guided by the European Society of Cardiology framework for grading recommendations, expert representatives achieved agreement on key priorities and structured actions to be undertaken in the first few minutes of resuscitation.
The consensus outlines early recognition of circulatory inadequacy (mean arterial pressure <30 mm Hg or end-tidal CO₂ <2 kPa), prompt activation of multidisciplinary responders, reduction of Impella power to P2 before initiating cardiopulmonary resuscitation and structured division of patient-focused and device-focused teams. Device-specific troubleshooting algorithms are presented for suction, malposition, purge-system failure and mechanical malfunction. This multisociety consensus represents the first national standard for emergency management and resuscitation of patients supported by a left-sided Impella device and is intended to inform structured clinical training and improve patient outcomes through rapid, coordinated and physiologically tailored interventions.
Eight national organisations:
Association of Cardiothoracic Anaesthesia and Critical Care, British Association of Critical Care Nurses, British Cardiovascular Society, British Society of Heart Failure, Intensive Care Society, Faculty of Intensive Care Medicine, Resuscitation Council UK, and the Society for Cardiothoracic Surgery in Great Britain & Ireland.
Eleven UK centres managing Impella:
Barts Health NHS Trust, London; Bristol Royal Infirmary, Bristol; Freeman Hospital, Newcastle; Golden Jubilee National Hospital, Clydebank; Guy’s & St Thomas’ NHS Foundation Trust, London; Harefield Hospital, Harefield; King’s College Hospital NHS Foundation Trust, London; Royal Brompton Hospital, London; Royal Papworth Hospital NHS Foundation Trust, Cambridge; St George’s University Hospitals NHS Foundation Trust, London; University Hospitals Birmingham NHS Foundation Trust, Birmingham
