We aimed to study the prevalence of acute neurologic events during short-term support with Impella devices. 

We reviewed prospectively collected data of 79 consecutive persons implanted with Impella devices at a single, tertiary center between October 2010 to July 2018. Acute neurological events (ANE) were defined as ischemic strokes or intracranial hemorrhages, including intracerebral, subarachnoid, and subdural hemorrhages. Among those with ANE, specific cases of ischemic and hemorrhagic events were explored.

Of 79 persons with Impella with a median of 8 days of cardiac support (range 1-33 days), 6 (8%) developed acute neurological events at a median of 6 days from implant to ANE (range 1-8 days). There were 3 ischemic strokes (50%), 2 intracerebral hemorrhages (33%), and 1 subdural hematoma (17%). Hemorrhagic events were attributed to anticoagulant use and thrombocytopenia at the time of the events.  Two ischemic strokes were attributed to inadequate anticoagulation with one case of pump thrombosis diagnosed at time of ischemic stroke. Only 2 of the 6 patients survived the acute cardiogenic shock period to go on to heart transplantation.

Ischemic strokes and intracranial hemorrhagic events are not uncommon during the short-term cardiac support period with Impella. Adequate anticoagulation and monitoring of thrombocytopenia might decrease the incidence of these events.