Impella in Transport: Physiology, Mechanics, Complications, and Transport Considerations

Gottula, Adam L.; Shaw, Christopher; Milligan, Justine; Chuko, Jonathan; Lauria, Michael J.; Swiencki, Amy; Bonomo, Jordan; Ahmad, Saad; Hinckley, William R.; Gorder, Kari

doi:10.1016/j.amj.2021.10.003

Cited by 11 publications

(11 citation statements)

References 42 publications

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“…33 Before attempting a transport of a pediatric patient supported with Impella, the nurse of the transport team should be prepared to manage these three important points: (a) the battery charge of the automated Impella controller, (b) where and how to secure the automated Impella controller during transport and c), the potential presence of air in the purge solution bag. 29 The automated Impella controller works with an AC of 100-230 V, however, it can also run on battery power alone (internal battery 14.4 V) for a maximum of 60 min. Thus, for long transportation, it is mandatory to use a built-in direct current to AC power inverter.…”

Section: Transport With Impellamentioning

confidence: 99%

“…28 When arrhythmias are not related to the catheter position both cardiopulmonary resuscitation (CRP) and defibrillation can be done without stopping the device; however, if CRP is needed, the level of Impella assistance should be reduced to P2 to avoid cardiac injuries (Table 7-8 Supplement). 29 Limb ischemia is another potential complication associated with the use of the Impella catheter (Table 9 Supplement). The pediatric nurse should frequently monitor the development of limb ischemia by checking the distal arteries pulsatility, the different temperature between the two legs, the skin color and the perfusion of to the leg with the near infrared spectroscopy (NIRS).…”

Section: Smentioning

confidence: 99%

“…In-hospital, helicopter and fixed wing transportation can be safely done in patients supported with Impella. 29,32 However, the pediatric nurse must be aware of some important aspects (Table 10 Supplement) and when the Impella is combined with ECMO (ECPELLA), the ECMO transport guidelines from the Extracorporeal Life Support Organization should be also followed. 33 Before attempting a transport of a pediatric patient supported with Impella, the nurse of the transport team should be prepared to manage these three important points: (a) the battery charge of the automated Impella controller, (b) where and how to secure the automated Impella controller during transport and c), the potential presence of air in the purge solution bag.…”

Section: Transport With Impellamentioning

confidence: 99%

“…When arrhythmias are not related to the catheter position both cardiopulmonary resuscitation (CRP) and defibrillation can be done without stopping the device; however, if CRP is needed, the level of Impella assistance should be reduced to P2 to avoid cardiac injuries ( Table 7-8 Supplement ). 29 …”

Section: Complications Associated With Use Of Impellamentioning

confidence: 99%

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What the pediatric nurse needs to know about the Impella cardiac assist device

Borrelli,

Nittolo,

Bochicchio

et al. 2024

Perfusion

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Background: Cardiogenic shock in children still carries a high mortality risk despite advances in medical therapy. The use of temporary mechanical circulatory supports is an accepted strategy to bridge patients with acute heart failure to recovery, decision, transplantation or destination therapy. These devices are however limited in children and extracorporeal membrane oxygenation (ECMO) remains the most commonly used device. Veno-arterial ECMO may provide adequate oxygen delivery, but it does not significantly unload the left ventricle, and this may prevent recovery. To improve the likelihood of left ventricular recovery and minimize the invasiveness of mechanical support, the Impella axial pump has been increasingly used in children with acute heart failure in the last decade. Purpose: There are still limited data describing the Impella indications, management and outcomes in children, therefore, we aimed to provide a comprehensive narrative review useful for the pediatric nurses to be adequately trained and acquire specific competencies in Impella management.

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Section: Transport With Impellamentioning

confidence: 99%

Section: Smentioning

confidence: 99%

Section: Transport With Impellamentioning

confidence: 99%

Section: Complications Associated With Use Of Impellamentioning

confidence: 99%

See 2 more Smart Citations

What the pediatric nurse needs to know about the Impella cardiac assist device

Borrelli,

Nittolo,

Bochicchio

et al. 2024

Perfusion

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“…In addition to extracorporeal membrane oxygenation (ECMO), such devices include intra-aortic balloon pumps (IABP) and the Impella device (Abiomed, Danvers, MA). [3][4][5][6] Patients requiring placement of IABP and Impella devices are often subsequently transferred to tertiary or quaternary centers, requiring critical care transport medicine (CCTM) providers to manage patients supported by these devices. Reflecting the importance of management during transfer, four case series of IABPsupported patients transported by helicopter air ambulance (HAA) have been published.…”

Section: Introductionmentioning

confidence: 99%

Management of patients with impella devices or intra-aortic balloon pumps during helicopter air ambulance transport in observational data

et al. 2023

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Introduction Placement of percutaneous ventricular support devices such as an intraaortic balloon pump (IABP) or Abiomed Impella device can treat severe cardiogenic shock. Critical care transport medicine (CCTM) providers frequently manage patients supported by these devices during interfacility transfers, often using a helicopter air ambulance (HAA). An understanding of patient needs and management during transport is essential to informing crew configuration and training, and this study adds to the limited existing data on the HAA transport of this complex patient population. Methods We performed a retrospective chart review of all HAA transports of patients with an IABP ( n = 38) or Impella ( n = 11) device at a single CCTM program from 2016 to 2020. We evaluated transport times and composite variables for the frequency of adverse events, condition changes requiring critical care evaluation, and critical care interventions. Results In this observational cohort, patients with an Impella device more frequently had an advanced airway and at least 1 vasopressor or inotrope active prior to transport. While flight times were similar, CCTM teams remained at referring facilities longer for patients with an Impella device (99 vs 68 minutes; p = 0.0097). Compared to patients with an IABP, patients with an Impella device more frequently had a condition change requiring critical care evaluation (100% vs 42%; p = 0.0005) and more frequently received critical care interventions (100% vs 53%; p = 0.0037). Adverse events were uncommon and did not differ for patients with an Impella device compared to an IABP (27% vs 11%; p = 0.178). Conclusion Patients requiring mechanical circulatory support with IABP and Impella devices frequently require critical care management during transport. Clinicians should ensure the CCTM team has appropriate staffing, training, and resources to meet the critical care needs of these high acuity patients.

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