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

Abstract

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.

AHN LifeFlight, 45 Years in the Making

“…Each model brought a smaller, more easily managed machine that no longer required a perfusionist at the bedside. 5 Today's IABPs are lightweight, rapidly deployed, and automatically augment and time inflation and deflation. Only the pump rescue unit is now utilized for transport in-flight; weighing 53 lb, it is much easier to load and maneuver.…”

“…With innovation and technology, the pumps have gone through multiple improvements. Each model brought a smaller, more easily managed machine that no longer required a perfusionist at the bedside 5. Today's IABPs are lightweight, rapidly deployed, and automatically augment and time inflation and deflation.…”

Timing and treatment strategies according to SCAI classification in cardiogenic shock

“…In selected cases, due to the haemodynamic instability of the patients making the transfer at a really high risk of mortality, a dedicated hub centre’s team may place a percutaneous tMCS at the spoke centre for a protected transfer. 41 …”