@AHajduczok Learning objectives:
💔 history of the Impella
💔 learn how it works
💔 how to troubleshoot when it doesn't work
@AHajduczok The Impella is based on concept from Egypt in the 3rd Century BC
The Greek mathematician Archimedes, developed a machine to raise water up while in Egypt. The machine consists of a screw within a hollow cylinder that transfers water upwards by each segment of the screw.
@AHajduczok Dr. Richard Wampler adapted the design in 1985 by inventing the Hemopump, the first intravascular axial flow LV support device.
In 1988, the Hemopump was successfully implanted in a patient at @Texas_Heart. However, it was never a commercial success and was soon discontinued.
@AHajduczok@Texas_Heart In 1991, Dr. Thorsten Siess modified the Hemopump to include a shorter rotor and the addition of a motor on the catheter itself.
This gave rise to the Impella class of products that were approved for clinical use in Europe (2005) and the US (2008).
It is a measure of flow that corresponds to both motor current and RPMs of the device
Factors such as improper positioning and suction events can reduce flow rates at a given P level
...but what is the right position??
@AHajduczok@Texas_Heart Using both TTE and TEE, optimal positioning includes (see 👇):
1️⃣ inlet 3.5 cm below aortic valve
2️⃣ outlet well above the aortic valve
3️⃣ catheter angled toward the LV apex
⬇️ P level to P2 and (normally under fluoroscopic or echo guidance) slowly advance/retract the catheter until the inlet is located 3.5cm below the aortic valve annulus
THEN, slowly re-establish flow up to the desired P level
🩸 Correct any positioning or suction alarms
🩸 repeat labs to prove that hemolysis is occurring
🩸 give back fluid or blood if CVP or PCWP <10mmHg
@AHajduczok@Texas_Heart Remember, do not touch the Impella if you are not familiar and trained with the device and only if and when you have approval from your attending. If you are a resident, call your fellow and/or attending immediately if these issues arise.
@AHajduczok@Texas_Heart Hopefully you found this🧵 helpful, and it will make your time in the CCU just a little bit easier!
Developed in the 1950s by the Kantrowitz brothers, IABPs have been in clinical practice since the first implant in 1967 at @MaimonidesMC Currently, it is still widely used as modest temporary mechanical circulatory support for cardiogenic shock
The mechanism of IABP begins with rapid deflation of the helium filled balloon (helium moves faster than air) at the onset of systole. This creates a vacuum effect which reduces the work load of the heart during all of systole thereby reducing afterload