Impella Weaning and Escalation
Best Practices for Patients Supported with Impella® (Part 6)
Dr. Behnam Tehrani highlights key considerations for escalating or weaning Impella® support in this sixth and final video of the Best Practices for Patients Supported with Impella series.
Dr. Tehrani identifies several key elements to consider for weaning or escalation, including cardiac output, cardiac power output, signs of end-organ perfusion, urinary output, LFTs, lactate, and pressor requirements. He presents an algorithm that considers CPO, RV dysfunction, and hypoxemia as key determinants in assessing of whether to wean the patient from Impella support or escalate to RV support, Impella 5.0®, or a durable LVAD.
If the patient is ready to be weaned from Impella support, Dr. Tehrani offers the following steps for weaning:
- To initiate weaning, reduce P level in 2 level increments (eg, P8 to P6 to P4) as hemodynamics tolerate.
- Keep Impella at P2 until you are ready to explant the device from the left ventricle.
- Once hemodynamics allow—CVP ~10-12, CI>2—pull the catheter from the left ventricle into the aorta at P2.
- Check ACT and remove Impella when ACT<150-160. (May pre-close in cath lab.)
- Disconnect the device from the Automated Impella Controller (AIC).
- Apply manual compression for about 40 minutes.
In conclusion, Dr. Tehrani offers this advice for institutions to follow. “Whatever you do at your institution, just make sure it’s standardized. Make sure it is something that everybody understands, and everybody is cognizant of. And just make sure that it’s followed. And ultimately, review all your cases. The way you will move the standard of care forward, and move the needle, is to not only have low variation in care, but always to review the cases and make sure that you’ve done everything well.”
Dr. Tehrani also highlights that the Abiomed Clinical Support Center (CSC) team is available 24/7 to provide support from pre-implant assessment through daily patient management, providing best practices and troubleshooting guidance for all aspects of device and patient management.
Videos in this series:
- Part 1: Overview and Initial Management Tips
- Part 2: Impella Waveforms, Positioning, and Repositioning
- Part 3: Dr. Behnam Tehrani Discusses Hemolysis
- Part 4: Addressing Impella Alarms
- Part 5: Impella Groin Management
- Part 6: Impella Weaning and Escalation (current page)
- Escalation Strategies That Increase Unloading
- Facilitating Impella Weaning and Explant Decision Making
- Using Impella CP with SmartAssist® to Guide Successful Weaning in High-Risk PCI Procedure
To learn more about the Impella® platform of heart pumps, including important risk and safety information associated with the use of the devices, please visit: abiomed.com/important-safety-information