Cardiac Rehabilitation in Severe Heart Failure Patients with Impella 5.0 Support via the Subclavian Artery Approach Prior to Left Ventricular Assist Device Implantation

Abstract

Impella 5.0 circulatory support via subclavian artery (SA) access may be a safe approach for patients undergoing cardiac rehabilitation (CR). In this case series, we retrospectively analyzed the demographic characteristics, physical function, and CR data of six patients who underwent Impella 5.0 implantation via the SA prior to left ventricular assist device (LVAD) implantation between October 2013 and June 2021. The median age was 48 years, and one patient was female. Grip strength was maintained or increased in all patients before LVAD implantation (pre-LVAD) compared to after Impella 5.0 implantation. The pre-LVAD knee extension isometric strength (KEIS) was less than 0.46 kgf/kg in two patients and more than 0.46 kgf/kg in three patients (unavailable KEIS data, n = 1). With Impella 5.0 implantation, two patients could ambulate, one could stand, two could sit on the edge of the bed, and one remained in bed. One patient lost consciousness during CR due to decreased Impella flow. There were no other serious adverse events. Impella 5.0 implantation via the SA allows mobilization, including ambulation, prior to LVAD implantation, and CR can be performed relatively safely.

Effects of acute phase intensive electrical muscle stimulation in COVID-19 patients requiring invasive mechanical ventilation: an observational case-control study

“…EMS was applied to the bilateral upper and lower limb muscles (biceps brachii, quadriceps femoris, and gastrocnemius muscles: middle of the upper arm and approximately 2 cm above the cubital fossa for biceps brachii, approximately 5 cm below the inguinal fold and 3 cm above the upper patella border for the quadriceps femoris, and approximately 3 cm below the popliteal fossa and immediately above the proximal end of the Achilles tendon for the gastrocnemius muscles) with a stimulator (Solius; Minato Medical Science, Osaka, Japan) using self-adhesive surface electrodes (40 × 80 mm). The EMS intervention included as part of the standard rehabilitation therapy for patients with respiratory or circulatory failure and postoperative patients in the ICU in our institution was reported previously 20 – 22 . We applied EMS with a variable-frequency train that began with high-frequency bursts (200 Hz), followed by low-frequency stimulation (20 Hz), and EMS was applied as a symmetrical biphasic square wave with 0.4-s pulses of direct current followed by a 0.6-s pause.…”