Impella Management for the Cardiac Intensivist

Papolos, Alexander; Barnett, Christopher F.; Tuli, Aakash; Vavilin, Ilan; Kenigsberg, Benjamin

doi:10.1097/mat.0000000000001680

Cited by 12 publications

(31 citation statements)

References 8 publications

(8 reference statements)

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“…The catheter tip lies in the left ventricle and suctions blood from the left ventricle and disperses it into the ascending aorta. Impella CP support provides left ventricular unloading, increases systemic perfusion, and increases coronary blood flow [ 2 ]. Among the variety of Impella catheters, Impella CP is most often used in the catheterization laboratory since it allows for percutaneous insertion and provides a maximum of 3.7 L/min of flow, which is appropriate in most cases of cardiogenic shock.…”

Section: Discussionmentioning

confidence: 99%

Save the Leg: Utilization of Distal Perfusion Catheter With Impella CP® May Prevent Morbidity of Limb

McDermott¹,

Cook²,

Park³

et al. 2022

Cureus

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Leg ischemia is a potential complication of percutaneous left ventricular assist device (Impella CP®) placement. To avoid leg ischemia in at-risk patients, a distal perfusion catheter (DPC) should be placed. In utilizing a passive distal perfusion system from the contralateral femoral artery, we optimized blood flow to the distal limb mitigating leg ischemia. A 65-year-old female with dilated cardiomyopathy complicated by hemodynamic instability was placed on an Impella CP via the right femoral artery. A DPC was placed to the right distal femoral artery and connected to the wire re-access port of the Impella CP. Despite this, the leg became ischemic shortly after admission to the ICU. A contralateral femoral arterial line was placed in standard fashion, and it was connected to the DPC while the wire re-access port was capped. Shortly after placement of the new DPC system, the right lower extremity distal pulses returned, and distal leg ischemia was resolved. Another patient, a 67-year-old male with acute myocardial infarction, was placed on an Impella CP via the left femoral artery for cardiogenic shock. His hemodynamics continued to deteriorate, requiring initiation of veno-arterial extracorporeal membrane oxygenation (VA ECMO) via the right femoral artery and vein with associated DPC placement. Shortly after the initiation of VA ECMO, the Impella CPrelated extremity (left leg) became ischemic. A left femoral DPC was placed and connected to the side port of the right femoral arterial cannula. After initiation of the additional DPC system, the left leg ischemia resolved. Distal leg ischemia with Impella CP is not a rare event. Utilization of a DPC to Impella CP may decrease the morbidity of limb malperfusion.

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Section: Discussionmentioning

confidence: 99%

Save the Leg: Utilization of Distal Perfusion Catheter With Impella CP® May Prevent Morbidity of Limb

McDermott¹,

Cook²,

Park³

et al. 2022

Cureus

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“…The risk may be prohibitive in many circumstances and, therefore, the interventional cardiologist must be able to recognize factors that may lead to potential vascular complications. 15 …”

Section: Management Of Limb Ischaemia During Impella Supportmentioning

confidence: 99%

“…For elective procedures, a baseline angiography of the ileofemoral arteries performed from a contralateral or radial access can be useful in patients with suspected peripheral artery disease. 15 Furthermore, a detailed assessment of the specific vascular complication should be achieved by selective peripheral angiography (radial or contralateral femoral artery). In addition, a successful attempt of crossing the occluded artery with a guidewire might allow sealing dissection with a stent, removal of thrombus and thromboembolism with an extraction catheter, and eventually facilitate haemostasis with balloon inflation ( Figure 2D ).…”

Section: Management Of Limb Ischaemia During Impella Supportmentioning

confidence: 99%

“… 10 Additional parameters, depending on the type of monitoring, are central venous pressure, pulmonary capillary wedge pressure, mixed central venous oxygen saturation, and pulmonary artery pulsatility index. 15 Furthermore, a patient can deteriorate due to respiratory failure or profound cardiogenic shock with multi-organ failure despite Impella support. 15 All of the above-mentioned causes might necessitate further escalation of MCS in order to improve gas exchange or provide better haemodynamic support.…”

Section: Procedural Options For Patient Deterioration During Impella ...mentioning

confidence: 99%

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Optimal bail-out and complication management strategies in protected high-risk percutaneous coronary intervention with the Impella

Sinning

Ibrahim

Schröder

et al. 2022

European Heart Journal Supplements

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Despite the routine use of percutaneous mechanical circulatory support (pMCS) with the Impella heart pump, vascular and bleeding complications may occur during removal with or without pre-closure. To safely close the large-bore access (LBA), post-hoc selection of the appropriate treatment of vascular complications is critical to patient recovery and survival. Femoral artery access is typically utilized for LBA, and percutaneous axillary artery access is a common alternative, especially in the instance of severe peripheral artery disease. Optimization of patient outcomes and efficiency of pMCS can be achieved with adequate arterial access using state-of-the-art techniques. Impella removal techniques with or without pre-closure will be addressed as well as the management of large-bore femoral access complications. In addition, treatment strategies to manage patient deterioration during a protected high-risk percutaneous coronary intervention will be provided.

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“…9 In this issue of the Journal, Impella platforms are explored by addressing both the clinical aspects in an ICU setting as an overview (and single-center experience) as well as a contemporary registry analysis from the United Network of Organ Sharing (UNOS), describing characteristics and outcomes associated with its use before HT. 10,11…”

mentioning

confidence: 99%

A New Dawn for Transvalvular Pumps for Ventricular Unloading as a Bridge to Heart Transplantation

2022

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Impella Management for the Cardiac Intensivist

Cited by 12 publications

References 8 publications

Save the Leg: Utilization of Distal Perfusion Catheter With Impella CP® May Prevent Morbidity of Limb

Save the Leg: Utilization of Distal Perfusion Catheter With Impella CP® May Prevent Morbidity of Limb

Optimal bail-out and complication management strategies in protected high-risk percutaneous coronary intervention with the Impella

A New Dawn for Transvalvular Pumps for Ventricular Unloading as a Bridge to Heart Transplantation

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