{
  "abstract": "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.",
  "authors": [
    {
      "affiliations": [
        "St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK",
        "Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK",
        "Faculty of Intensive Care Medicine, London, UK"
      ],
      "name": "Waqas Akhtar"
    },
    {
      "affiliations": [
        "Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Christopher T Bowles"
    },
    {
      "affiliations": [
        "Royal Papworth Hospital, Cambridge, UK"
      ],
      "name": "Pierluigi Costanzo"
    },
    {
      "affiliations": [
        "Resuscitation Council UK, London, UK"
      ],
      "name": "Charles D Deakin"
    },
    {
      "affiliations": [
        "Faculty of Intensive Care Medicine, London, UK"
      ],
      "name": "Pauline Elliot"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle upon Tyne, UK"
      ],
      "name": "Mostafa Eladawy"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, UK",
        "British Society for Heart Failure, London, UK"
      ],
      "name": "Roy S Gardner"
    },
    {
      "affiliations": [
        "Bristol Royal Infirmary, University Hospitals Bristol, Bristol, UK"
      ],
      "name": "Matthew Govier"
    },
    {
      "affiliations": [
        "St Georges University Hospital, London, UK"
      ],
      "name": "Rhodri Handslip"
    },
    {
      "affiliations": [
        "Royal Brompton Hospital, Guy's and St Thomas NHS Foundation Trust, London, UK"
      ],
      "name": "Jonathan Hill"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Ajay Jain"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Sohail Q Khan"
    },
    {
      "affiliations": [
        "University Hospital of Wales, Cardiff, UK"
      ],
      "name": "Ifan Lewis"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Hoong Sern Lim"
    },
    {
      "affiliations": [
        "Bristol Royal Infirmary, University Hospitals Bristol, Bristol, UK"
      ],
      "name": "Mark Mariathas"
    },
    {
      "affiliations": [
        "Barts Health NHS Trust, London, UK"
      ],
      "name": "Clare Mellis"
    },
    {
      "affiliations": [
        "Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Maria Monteagudo-Vela"
    },
    {
      "affiliations": [
        "British Association of Critical Care Nurses, London, UK"
      ],
      "name": "Ian Naldrett"
    },
    {
      "affiliations": [
        "Intensive Care Society, London, UK"
      ],
      "name": "Marlies Ostermann"
    },
    {
      "affiliations": [
        "St Thomas' Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Divaka Perera"
    },
    {
      "affiliations": [
        "Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Sofia Pinto"
    },
    {
      "affiliations": [
        "University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK"
      ],
      "name": "Carla Richardson"
    },
    {
      "affiliations": [
        "Society for Cardiothoracic Surgery in Great Britain and Ireland, London, UK"
      ],
      "name": "Aaron Ranasinghe"
    },
    {
      "affiliations": [
        "Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Fernando Riesgo Gil"
    },
    {
      "affiliations": [
        "Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Alex Rosenberg"
    },
    {
      "affiliations": [
        "Freeman Hospital, Newcastle upon Tyne, UK"
      ],
      "name": "Stephan Schueler"
    },
    {
      "affiliations": [
        "Golden Jubilee National Hospital, Clydebank, UK"
      ],
      "name": "Andrew Sinclair"
    },
    {
      "affiliations": [
        "British Cardiovascular Society, London, UK"
      ],
      "name": "Neil Swanson"
    },
    {
      "affiliations": [
        "St Georges University Hospital, London, UK"
      ],
      "name": "Simon Wilson"
    },
    {
      "affiliations": [
        "King's College Hospital NHS Foundation Trust, London, UK"
      ],
      "name": "Ian Webb"
    },
    {
      "affiliations": [
        "Intensive Care Society, London, UK"
      ],
      "name": "Stephen Webb"
    },
    {
      "affiliations": [
        "Association of Cardiothoracic Anaesthesia and Critical Care, London, UK"
      ],
      "name": "Christopher Walker"
    },
    {
      "affiliations": [
        "Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK"
      ],
      "name": "Vasileios Panoulas"
    }
  ],
  "title": "UK multisociety consensus statement on the emergency management and resuscitation of patients with left-sided Impella support",
  "uid": "d42ca500-2286-591c-a2a4-4bd5db726f29"
}