The use of mechanical circulatory support for patients presenting with cardiogenic shock is rapidly increasing. Currently, there is only limited and conflicting evidence available regarding the role of the Impella (a microaxial, continuous-flow, short-term, left or right ventricular assist device) in cardiogenic shock; further randomized trials are needed.

Patient selection, timing of implantation, and post-implantation management in the cardiac intensive care unit are crucial elements for success.

Particular challenges at the bedside include the practical management of anticoagulation, evaluation of correct device position, and the approach to use in a patient with signs of insufficient hemodynamic support.

Profound knowledge of these issues is required to enable the maximal potential of the device.

This review provides a comprehensive overview of the short-term assist device and describes a practical approach to optimize care for patients supported with the device.

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