Impact of Impella 5.5 Duration Support and Clinical Outcomes in Cardiogenic Shock: Evidence from a Systematic Review and Meta-Analysis of Observational Studies

Background:The Impella 5.5 is FDA-approved for up to 14 days of support in patients with cardiogenic shock, however, its extended use is increasingly employed as a bridge to advanced therapies. Aim:To compare outcomes with short-term (14 days) versus prolonged (>14 days) Impella 5.5 support in patients with cardiogenic shock. Methods:Multiple databases were searched through September 2025 to identify relevant studies, and five studies met the inclusion criteria, encompassing total of 1,440 patients.Pooled risk ratios (RRs) with 95% confidence intervals (CI) were calculated using a random-effects meta-analysis in R-software. Results:Prolonged Impella 5.5 support (> 14 days) was associated with a higher likelihood of successful bridging to heart transplantation (RR:1.96,95% CI:1.01-3.83;p=0.049), and with lower in-hospital mortality rate (RR:0.67,95% CI:0.53-0.84;p=0.011).However, native heart survival or recovery (RR: 0.70, 95% CI: 0.54-0.90;p=0.026) was significantly lower with prolonged support.There was no significant difference in bridging to durable LVAD between the groups (RR:0.86;95% CI: 0.54-1.36,p=0.28).Prolonged Impella support was associated with higher risks of insertion-site hematoma (RR: 1.55, 95% CI: 1.07-2.24;p=0.036) and infection (RR:3.36,95% CI: 2.71-4.17;p=0.002), while stroke rates were similar between groups (RR:1.34;95% CI: 0.96-1.89;p=0.074). Conclusions:Extending Impella 5.5 support beyond 14 days in patients with cardiogenic shock appears advantageous for select patients, conferring improved survival and higher likelihood of successful bridging to heart transplantation.J o u r n a l P r e -p r o o f However, significantly higher risk of implant-site hematoma and infection necessitates meticulous vascular management, infection-prevention strategies and close clinical surveillance.