Impella - the tiny heart pump helping doctors pull patients back from the brink

When the heart suddenly becomes too weak to pump enough blood around the body, it can quickly become a life-or-death emergency. The Impella — the world’s smallest heart pump — acts like a temporary “backup motor” for the heart, keeping blood flowing while doctors work to save the patient and treat the underlying problem. In those critical moments, the tiny device can give the heart a chance to rest, recover and keep beating. The catch is: Impella is not funded in New Zealand, so the only option for patients who find themselves in this situation is to be treated with medication, which is often less effective and more invasive. We spoke with interventional cardiologist Dr Sergej Cicovic about this life-saving device and the struggles to get it funded in New Zealand.

One of the most serious challenges for cardiologists (heart doctors) is a condition called cardiogenic shock, which occurs when the heart cannot pump enough blood around the body.

When this happens, it is sudden and an extreme medical emergency. If the heart doesn’t get enough blood and oxygen, the heart muscle can start to die. The faster doctors can restore blood flow, the better the chances of saving a patient’s life and supporting recovery.

The Impella is a small mechanical heart pump that doctors temporarily implant in the heart to help it pump blood. In simple terms, it acts as a “backup motor” for the heart when it is too weak to do its job.

This life-saving device is helping cardiologists around the world to save people in cardiogenic shock after events such as a severe heart attack, heart failure, an abnormal heart rhythm, or a large blood clot in an artery in the lungs (pulmonary embolism).

The Impella helps quickly restore blood pressure and flow, thereby protecting the body’s most vital organs.

The Impella is a miniature pump placed in the heart, via a catheter, often inserted through the femoral artery in the leg and advanced into the heart. Once in place, the Impella draws blood from the left ventricle and delivers it directly into the aorta, supporting the heart's natural cardiac output.

Dr Sergej Cicovic, an interventional cardiologist and specialist in cardiology and cardiac interventions, explains that the little heart pump is small but mighty – about the size of a Bic pen.

He describes the Impella as “a micro-heart pump that mimics what the real heart does by squeezing blood out of the heart’s pumping chamber and into the aorta”.

“The Impella is a ‘bridge’ to either recovery or to something like a stent or bypass”.

For 26 years, the chance of surviving cardiogenic shock remained unchanged, with only a 50-50 chance of living.

What sets the Impella apart is its ability to significantly improve survival chances in patients experiencing cardiogenic shock — where previous mortality rates were very high.

The improvement is so significant that the survival rate has risen from approximately 50% to 79%.

The catch is: Impella is expensive.

The device costs about $40,000 per use and is not re-usable.

“It stays in for about 10 days to 14 days max, and then you've got to take it out and throw it away," Dr Cicovic explains.

Despite this, it is still considered cost-effective.

Studies consistently show that Impella is more cost-effective than alternatives for many cardiac patients. It is associated with shorter hospital stays, fewer complications, including a lower risk of renal failure, and reduced hospital readmissions, leading to significant cost savings.

The alternatives to Impella often incur higher overall costs due to the complexity of ICU care, he says.

“So Impella is generally cost-neutral or slightly cheaper because patients spend fewer days in ICU."

Impella can dramatically cut hospital costs and reduce hospital length of stay, for example, in ICU recovery from about 11 days to seven days.

The Impella is also a quick and simple device to use.

"It can be done in about nine to 13 minutes with a slick team,” Dr Cicovic says.

Because Impella is not yet a mainstream, accessible procedure in New Zealand for patients who go into cardiogenic shock, the alternatives leave patients with options that can be less effective and more invasive.

One current treatment for stabilising the heart after cardiogenic shock involves administering medications (inotropes and vasopressors). The downside is that for every drug given, the heart must work harder, and if the heart already has a blood clot, the drugs can cause even more damage to the heart.

“We've had medications like adrenaline and noradrenaline for 60 years or so, but they come with risks," Dr Cicovic says.

“The more drugs you need, the more likely you are to die, so there's obviously a confounder.”

The alternatives to the Impella are less effective at unloading the heart, and some alternatives, like medications, increase strain on the heart, with outcomes that can be poorer in severe cardiogenic shock, he says.

Another current alternative to Impella, if you live in Auckland, is extracorporeal membrane oxygenation (ECMO), a form of life support used for decades that can temporarily take over the work of the heart and/or lungs.

It works by circulating blood outside the body to deliver oxygen and remove carbon dioxide, supporting patients iwth severe cardiogenic shock or respiratory failure.

Like the Impella, ECMO serves as a bridge to recovery or further treatment. However, while ECMO can temporarily support life in critically ill patients, evidence suggests that inhospital mortality is higher with ECMO than with Impella.

Impella is also less invasive than some alternatives because it is inserted via a catheter into an artery (usually in the leg).

The Impella device enables a minimally invasive procedure that goes into the heart without traditional open-heart surgery.

New Zealand is known for its slow process for approving new medical devices and drugs that patients urgently need.

It took two years to get approval to use the Impella in New Zealand.

The Impella device gained approval from Medsafe in December 2025.

Meanwhile, other countries have benefitted from the Impella for over 25 years.

At Toronto General Hospital, where Dr Cicovic was a fellow, 40 Impella procedures were performed in a single year, and around five other hospitals in Toronto also performed the same procedure using the Impella.

In New Zealand, he has been able to perform only one procedure. So far, only three procedures in New Zealand have used the Impella.

Establishing strong Impella programmes could make this technology accessible in at least five major centres nationwide.

Programmes that include cardiogenic shock protocol and specialists are still being finalised. They will include teams of specialists like interventional cardiologists, heart failure and transplant cardiologists. Teams and protocols will start being rolled out in Auckland in a matter of weeks.

With Dr Cicovic’s behind-the-scenes work to bring the Impella to the country, he now expects that, in the next three to five years, the Impella will be much more accessible to New Zealanders.

Dr Cicovic is advocating for Impella access to ensure patients in Dunedin have the same access as those in Auckland, preventing a postcode lottery in which only certain regions benefit from improved survival rates in cardiogenic shock.

“So that it's not a postcode lottery as to who gets the benefit of Impella, and who's going to survive cardiogenic shock,” Dr Cicovic says.

Currently, procedures like ECMO are only available in Auckland, making for an inequitable service if you experience cardiogenic shock in another part of the country.

New Zealand has a lot of catching up to do, including educating cardiologists about the availability of the Impella device and its potential benefits for patients.

“New Zealand is significantly behind in all sorts of programmes to do with the Impella, including intensive ICU, cath lab, and patient selection training for the Impella”, Dr Cicovic says.

One big step was getting the Impella approved for use in New Zealand, but Dr Cicovic states that the next step is to get people familiar and comfortable in using it.

“At the moment, there's a bit of fear or hesitation about using the Impella because people don't know it or when to use it, so I think it's really important just to get exposure.”