SCCM Resource Library-Impella Quick Help Guide

Pdf Summary

The Impella Quick Help Guide created by Dr. Raymond A. Pashun, MD, FACC, is a resource designed to assist clinicians using the Impella CP device, a percutaneous left-ventricular assist device. This guide outlines the key indications, contraindications, initial considerations, optimal parameters, and common issues associated with the device.

<strong>Indications for Use:</strong>
The Impella CP is indicated for patients experiencing left ventricular (LV) failure or cardiogenic shock.

<strong>Contraindications:</strong>
The device should not be used in patients with severe aortic regurgitation, mechanical aortic valves, peripheral vascular disease, or LV thrombus.

<strong>Initial Considerations Post-Placement:</strong>
1. Confirm device position using transesophageal echocardiogram (TTE).
2. Check the groin or access site for complications.
3. Review the Impella screen for device function.
4. Monitor patient hemodynamics.
5. Keep track of urine output and signs of hemolysis.

<strong>Optimal Impella Parameters:</strong>
- Position inlet 3.5-4 cm from the aortic annulus.
- Optimize preload with a central venous pressure (CVP) of 8-10.
- Keep pulmonary artery pulsatility index (PAPi) above 1.0.
- Maintain mean arterial pressure (MAP) between 70-90 for afterload reduction.
- Ensure the insertion site angle is between 30-45 degrees.
- Utilize heparin via purge line with anti-Xa levels of 0.15-0.5.

<strong>Common Issues and Troubleshooting:</strong>
- <strong>Hemolysis</strong>: Symptoms include increased LDH and haptoglobin, and hematuria. Check device position, volume status, and consider lowering P level or upgrading the device if severe.
- <strong>Suction Alarms</strong>: Indicated by yellow alarm. Respond by assessing position and volume, and reducing P level if necessary.
- <strong>Improper Placement</strong>: Position alarms (red) indicate changes in waveforms. Adjust position with guidance, not advancing if too shallow.
- <strong>RV Failure</strong>: Suspect if suction alarms and PAPi under 1.0. Treatment may include diuresis or RV support.
- <strong>Insertion Site Complications</strong>: Manage bleeding or hematoma by checking insertion angle and addressing as needed. 

This guide is not endorsed by the Society of Critical Care Medicine but provides community-developed expertise for the use of Impella devices.

Asset Subtitle

Cardiovascular, 2025, 0:05:00

Asset Caption

This quick help guide provides information regarding impella placement, function and troubleshooting.

Meta Tag

Content Type Infographic

Knowledge Area Cardiovascular

Membership Level Associate

Membership Level Professional

Membership Level Select

Tag Cardiovascular

Year 2025

Keywords

Impella CP

left-ventricular assist device

cardiogenic shock

aortic regurgitation

hemodynamics

hemolysis

suction alarms

RV failure

insertion site complications

Dr. Raymond A. Pashun

Infographic

Cardiovascular

2025

Associate

Professional

Select

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