This prospective, single-arm observational study assessed serial sublingual microcirculation in 18 patients with cardiogenic shock undergoing Impella 5.5 placement. Immediately on support, microvascular flow index (p = 0.004) and proportion of perfused vessels (p = 0.003) improved, including after adjustment for vasoactive-inotropic score. Changes in microvascular heterogeneity index (p = 0.055) and perfused vessel density (p = 0.067) did not reach statistical significance. Improvements were greatest among patients with impaired baseline microcirculation; no systemic haemodynamic marker was sufficient to ensure adequate microcirculatory perfusion.
Full-support microaxial pump use was associated with improved microcirculatory measures, particularly when baseline perfusion was impaired. These exploratory physiological findings do not establish a device-specific benefit.
Study limitation: The small, single-arm study cannot separate device effects from overall clinical improvement, and its endpoints are physiological rather than patient-centred.
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