Successful echo-guided bedside placement of Impella 2.5 L in a patient with profound cardiogenic shock already supported by intra-aortic balloon pump

Cardiogenic shock (CS) remains a significant cause of in-hospital morbidity and mortality despite frequent use of mechanical circulatory devices, i.e., intra-aortic balloon pump (IABP) and Impella 2.5 (IMP), which are now considered a standard of care for treatment of severe CS refractory to pharmacological treatment. Herein, we present a challenging case of severe CS refractory to pharmacological and IABP support, where IMP was utilized in combination with IABP. IMP was inserted at bedside under transesophageal echocardiography (TEE) guidance giving the patient’s hemodynamic instability, which had prevented transportation to the catheterization lab. After this treatment strategy, the patient showed significant hemodynamic and clinical improvement, followed by weaning off pharmacological and mechanical support and was eventually discharged home.