Bleeding and thrombotic events during micro-axial flow pump support: A European multicenter cohort study

doi:10.1186/s13054-026-05984-0

Bleeding and thrombotic events during micro-axial flow pump support: A European multicenter cohort study

Crit CarePublished 13 Apr 2026Retrospective cohort study

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Authors' conclusion

In this large European mAFP cohort, bleeding and thrombotic events were frequent and associated with mortality and adverse outcomes.

Study context

Population: Patients with cardiogenic shock supported with micro-axial flow pump (Impella CP or Impella 5) at eleven high-volume European centers, 2010–202361% AMI-related cardiogenic shock (CS)
Participants: 1,043 patients

Outcome: ≥ 1 bleeding or thrombotic event during support

Methodological detailsmulticentre, Events adjudicated and normalized to annual implant volumes

Multicentre
Events adjudicated and normalized to annual implant volumes

Main finding

As reported in the abstract

≥ 1 event

503

48%

Bleeding only

252

Thrombosis only

149

Both bleeding and thrombosis

102

Observational data: associations, not effects.

Further findings

Independent predictors of bleeding

	← Lower odds ←→ Higher odds →	OR (95% CI)	P value
Post-cardiotomy CSMultivariable logistic regression	0.20.5125	2.64 (1.41–4.96)	P = 0.003
AMICSMultivariable logistic regression	0.20.5125	2.27 (1.38–3.74)	P = 0.001
V-A ECMO unloading indicationMultivariable logistic regression	0.20.5125	1.65 (1.14–2.39)	P = 0.008
RRT at implantationMultivariable logistic regression	0.20.5125	1.56 (1.08–2.27)	P = 0.019
	0.20.5125Odds ratio (log scale)

Predictors of thrombosis

	← Lower odds ←→ Higher odds →	OR (95% CI)
Prior stroke	0.20.5125	2.51 (1.40–4.51)
AMI-CS	0.20.5125	2.06 (1.42–3.00)
mAFP unloading with V-A ECMO	0.20.5125	2.03 (1.38–2.98)
	0.20.5125Odds ratio (log scale)

180-day mortality

	← Lower odds ←→ Higher odds →	OR (95% CI)
BleedingIndependently associated	0.20.5125	1.38 (1.02–1.87)
ThrombosisIndependently associated	0.20.5125	2.10 (1.53–2.88)
	0.20.5125Odds ratio (log scale)

Original publication

Bleeding and thrombotic events during micro-axial flow pump support: A European multicenter cohort study. Crit Care. Published 13 April 2026. doi:10.1186/s13054-026-05984-0

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