Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group

Abstract

Mechanical circulatory support represents an evolving field of clinical research and practice. Currently, several cardiac assist devices have been developed but, among different institutions and countries, a large variation in indications for use and device selection exists. The Impella platform is an easy to use percutaneous circulatory support device which is increasingly used worldwide. During 2014, we established a working group of European physicians who have collected considerable experience with the Impella device in recent years. By critically comparing the individual experiences and the operative protocols, this working group attempted to establish the best clinical practice with the technology. The present paper reviews the main theoretical principles of Impella and provides an up-to-date summary of the best practical aspects of device use which may help others gain the maximal advantage with Impella technology in a variety of clinical settings.

Advanced Percutaneous Mechanical Circulatory Support Devices for Cardiogenic Shock

“…When proper techniques are used, arterial complications of Impella 2.5 are similar to IABP. 45 With the exception of vascular injury, complications rates for Impella CP and 5.0 are reportedly comparable with Impella 2.5. 16,17,27 …”

“…If a suction event occurs, the patient should be assessed for hypovolemia as well as device location by echocardiogram or fluoroscopy. 45 Unique to Impella is a purge cassette with heparin solution, which is designed to prevent blood from entering the motor. Purge alarms can signal various complications along the system, including leakage, air, blood in the motor, or tube kinking.…”

“…Purge alarms can signal various complications along the system, including leakage, air, blood in the motor, or tube kinking. 45 …”

Percutaneous mechanical circulatory support: current concepts and future directions

“…38 The device consists of a microaxial pump that is mounted onto a pigtail catheter. Current percutaneous iterations include the 2.5 L/min, CP (up to 3.5 L/min) and 5.0 L/min devices, inserted via 13, 14 and 22 French (Fr) arterial sheaths, respectively.…”

High-risk percutaneous coronary intervention with Impella CP hemodynamic support. A case series and method presentation

“…However, IABP only modestly increases cardiac output and coronary blood flow, and may provide insufficient circulatory support when a hemodynamic collapse occurs [2, 3]. The Impella CP axial flow pump (ABIOMED Inc., Danvers MA, USA) is another percutaneous device, which offers more effective hemodynamic support compared to IABP [5, 6]. …”