Five surgical revisions for bleeding were necessary in 4 Impella patients (5/24; 21%), and no surgical source of the bleeding could be found in 3. Designed to allow access to … The mortality rate of patients with cardiogenic shock is often exponentially higher with medical therapy or other mechanical devices. The pump is retracted into the vascular graft which is then ligated flush with the ascending aorta or is oversewn, followed by standard closure of the sternotomy in the case of direct insertion into the ascending aorta. Authorized by Federal law (USA) to provide circulatory Heparin in the purge solution provides additional anticoagulation protection. Place repositioning sheath into trimmed graft . This is the largest series of patients undergoing placement of the Impella device for acute cardiogenic shock. Impella Field Guide: CP, 2.5 and 5.0 Impella Catheter Connector For Pressure Bag For Pressure Measurement Bacterial Filter With Air Trap, Pressure Reservoir And Check Valve Impella 2.5 Impella 5.0 Bacterial Filter With Air Trap, Pressure Reservoir And Check Valve System Configuration The percutaneous ventricular assist device is intended to be used as an … The indication for placement of the Impella device included cardiogenic shock in 15 patients (32%) and postcardiotomy cardiogenic shock in 32 (68%). The placement of the Impella device resulted in a relatively low complication rate, with only 14 complications occurring in the 47 patients. From in-depth professional resources to … One patient was brought back to the operating for placement of the Impella device after the patient's condition worsened postoperatively in the intensive care unit. The enclosure is designed to secure the Impella to the airframe while not compromising weight or maneuverability. Prevents blood from entering the catheter motor. The systemic heparin infusion may need to be adjusted accordingly. White Connector Cable . The results in this study demonstrate that the use of the Impella device in patients with cardiogenic shock has been very successful. Copyright © 2021 Elsevier Inc. except certain content provided by third parties. Briefly, the Impella 2.5 is a 12F microaxial pump mounted on a 9F catheter shaft housing the motor driveline and the purge line system. per mL: - Purge pressure: 300 to 700 mmHg: - Infusion rate: 4 to 12 mL/h : Maximum duration of use : 5 days: Dimensions of Impella® 2.5 Catheter : Length of invasive portion (w/o cannula): 130 +/- 3 mm: - Diameter: max. Do NOT use an Impella ® 2.5 System if any part of the system is damaged. In 2 patients with high purge pressures, the device was removed, and the Impella device was exchanged in the other patient. Without going into detail about the different power/rpm settings (P1 – P8), purge system, and other parameters, the intracardiac portion of the Impella consists of a pigtail to stabilize the catheter in the ventricle, an inflow where blood is suctioned from the LV, a radiopaque marker which is aligned with the aortic valve annulus under fluoroscopy, an outflow … Impella and ECMO combination therapy in cardiogenic shock provides the added Impella benefits of left ventricular unloading for myocardial recovery, end organ perfusion, ambulation and weaning, with the ECMO benefits of oxygenation. Of the 47 patients, 38 (80%) received the Impella 5.0 and the rest the 2.5 device. The Impella 5.0/LD device is also mounted on the same 9F catheter shaft, and the pump is 21F in diameter. Although none of the complications were minor, no patient died as a result of these complications. The kinking of the catheter was related to design issues; however, the manufacturer has reinforced the catheter, and most of these issues are now resolved. The outcomes from our study have results that are improved over historical data. Moreover, the 30-day mortality and complication rates were acceptable in these critical patients. Cardiogenic shock is characterized by inadequate tissue perfusion due to cardiac dysfunction and is the leading cause of death in patients hospitalized with acute myocardial infarction [. Higher (more viscous) concentr… These include the IABP, implantable turbine-pump (Hemopump; Medtronic Inc, Minneapolis, MN), percutaneous cardiopulmonary bypass support, and right heart, left heart, or biventricular assist devices. Acute cardiogenic shock is associated with high mortality rates. Training covers the full spectrum of therapy, from an overview of the technology, controller, and system set-up and insertion, through patient management … The patients with acute cardiogenic shock from acute myocardial infarction and the postcardiotomy patients both had a survival advantage when the Impella device was implanted (. lower dextrose concentrations are less viscous and flow more quickly with less … 4.0 mm) … In this study, the operative mortality and complication rate was acceptable in these critically ill patients. The purpose of our study was to determine the outcome of the Impella device for acute mechanical circulatory support in the cardiogenic shock setting at a large-volume single institution. Cardiogenic shock refractory to standard therapy with inotropes and/or intra-aortic balloon pump is accompanied with an unacceptable high mortality. The Axillary 5.0 kit has a _____ … 23 Purge Line Click-On Not Detected Check the purge line click-on and make sure it is fully inserted. dextrose concentration determines the viscosity and flow rate of the purge fluid. Another commonly used device is the TandemHeart Assist device (Cardiac Assist, Pittsburgh, PA), an LVAD designed for percutaneous insertion in the cardiac catheterization laboratory. Lightweight machined aluminium construction. Traditionally, a significant reduction of the mortality rate for patients with cardiogenic shock has not been observed despite early revascularization, advances in medical therapy, and mechanical hemodynamic support technology. Cardiogenic shock complicating acute myocardial infarction—a review. Short-term ventricular assist devices (VADs) have been become a widely accepted treatment option for acute cardiogenic shock. A retrospective record review of 47 patients who underwent placement of the Impella device was performed from January 1, 2006, to December 31, 2011. Cardiogenic shock is associated with a mortality of 35% to 80%.1,2 Lately, there has been a shift in reliance upon aggressive pharmacological therapy alone to a more hybrid approach, incorporating innovative mechanical therapy to conventional pharmacological management. We performed a retrospective record review of 47 consecutive patients with cardiogenic shock who underwent placement of the Impella device between February 2006 and December 2011. DOI: https://doi.org/10.1016/j.athoracsur.2013.07.053. Purge solution flows through the Impella® Catheter in the opposite direction of the patient’s blood being drawn into the catheter during support. The IMPELLA purge rate is not expected to vary substantially. It is inserted through the femoral artery and If the device is retrieved from the femoral or axillary artery insertion site, then manual compression at the groin or the axillary site that was used to achieve hemostasis. Clamp graft at anastamosis & backload Impella 5.0 6. Reversal of cardiogenic shock by percutaneous left atrial-to-femoral arterial bypass assistance. © 2014 The Society of Thoracic Surgeons. Abiomed is committed to sharing best practices and providing expert clinical training. The Impella System requires a purge system to: True. 4 different Impella support Catheters to accommodate range of cardiac flow requirements and implant techniques ; Catheter placed with cannula inflow located in left ventricle and outflow located in ascending aorta; AIC generates signals power drive motor of Catheter and provides user interface; AIC also incorporates disposable Impella Purge Cassette system fluid … It is easily placed, and as an internal device, can be placed minimally invasively through a transaxillary or transfemoral approach. If there is recovery of the LV, the Impella is removed. Figure 5.4 Inserting the Purge Cassette into the Automated Impella Controller 5.5 Figure 5.5 Inserting the Catheter Plug into the Connector Cable..... 5.6 Figure 5.6 Snapping Purge Clip to Connector Cable..... 5.6 Figure 5.7 Connecting the Luer to the Impella RP Catheter ..... 5.7 Figure 5.8 Priming the Purge ..... 5.7 Enter Purge Fluid Data..... 5.8 Figure 5.9 Entering Purge Fluid … The purge cassette delivers rinsing fluid to the Impella catheter. If the amount of UFH in the purge fluid leads to undesired systemic anticoagulant effects as measured by ACT or PTT, the concentration of UFH in the purge fluid can be reduced, 100mg/500mL D5 (can start at 25mg for 6hrs and then 50mg 6 hours after that if the bleeding is controlled) @ 4-20cc/hr, purge solution flows through the Impella in the opposite direction of the patient’s blood being drawn into the catheter, purge solution creates a pressure barrier that prevents blood from entering the Impella motor, dextrose concentration determines the viscosity and flow rate of the purge fluid, lower dextrose concentrations are less viscous and flow more quickly with less pressure through the purge system, higher (more viscous) concentrations result in a slower purge rate and greater pressure barrier. The Impella 2.5 and 5.0/LD devices are capable of generating up to 2.5 L/min and 5.0 L/min of forward flow in the systemic circulation, respectively. Purge solution, infusion tubing change every 24 hours Routine [ ] Dextrose 20% infusion 10-15 ml/hr, Intravenous, Continuous, Starting Today at 1300 For impella device.