Temporary circulatory assistance by ImpellaTM in interventional cardiology: Observational study and medico-economic assessment after four years of use

Objectives. - During life -threatening emergencies or risky cardiologic interventions, pharmacology can be limited and the use of appropriate medical devices is then necessary. The ImpellaTM catheter, CP and 2.5, has been referenced for the exclusive use of the interventional cardiology technical platform at Hopital Nord (AP-HM) in the absence of rapid access to the Extracorporeal Circulation unit. It is a temporary mechanical circulatory support device mainly indicated in refractory cardiogenic shock and coronary angioplasty at high risk of hemodynamic instability. The objective of this study, observational and retrospective, is to carry out a clinical and economic assessment linked to the use of this device over a period of four years (2017-2020). Methods. - The criteria relating to the 71 patients (51 ImpellaTM CP and 20 ImpellaTM 2.5) and their clinical evolution as well as the costs and valuation of the stays were determined. Results. - In particular, the ImpellaTM CP enabled myocardial recovery in 18 out of 51 patients and it was an intermediary in the context of heavier care for 11 patients. The balance between expenditure and valuation shows a deficit of -819,937 euros over the study period, with however a probable margin for improvement. Conclusions. - The ImpellaTM is of clinical interest under very specific conditions. Its high cost and the absence of inclusion on the list of reimbursements in addition to Homogeneous Groups of Stays represent a significant financial burden for health care establishments. Thus, optimizing the rating of future stays is a necessity. (c) 2023 Academie Nationale de Pharmacie. Published by Elsevier Masson SAS. All rights reserved.