Basics of the Impella

Impella is a temporary heart pump. A microaxial pump sucks blood from the ventricle and propels it systemically or to the lungs depending on where it is placed (left or right ventricle, respectively). The device is shaped to travel with the natural curvature of the heart
.
🤔Why use it?
Depending on size used, it can deliver 2.5-5L of blood flow/min. For reference, normal blood flow at rest is ~5-6L/min. It is doing the work of the heart when it physically can’t. Thus its used in cardiogenic shock and patients with poor heart function to assist in protected high risk PCI (percutaneous coronary intervention- placement of stents)
.
👩‍⚕️👨‍⚕️Who inserts it?
Interventional cardiologists in the cath lab via the femoral or axillary artery as a short term tool while awaiting cardiac recovery or as a bridge (±ECMO) in anticipation of possible permanent solutions (i.e. LVAD, transplant)
.
🔑 Limitations/Complications
1️⃣Size: Impella requires a large sheath. Left sided Impella may not be suitable for patients with significant peripheral vascular disease, or diseased narrow arteries of the body
2️⃣To prevent thrombus (clot) formation we use anticoagulation (blood thinner). So there is risk of both thrombus formation and bleeding . Impella can also cause turbulent blood flow causing hemolysis and can worsen anemia🩸
3️⃣Downstream limb ischemia
4️⃣Micro emboli & plaque disruption➡️stroke, peripheral embolization
5️⃣Damage to the myocardium, aortic valve
.
🔑Contraindications
1️⃣Mechanical aortic valves
2️⃣Significant aortic stenosis/regurgitation
3️⃣LV thrombus
4️⃣LV rupture
5️⃣Cardiac tamponade
6️⃣Severe PAD
.
🔑 Comments
Limited data exists on efficacy of Impella in cariogenic shock compared to IABP as quite difficult to study these very sick patients. Regardless, remains a valuable tool in the cardiologist’s armamentarium. Remember: 1️⃣ newer does not always mean better and 2️⃣every medication/therapy has intrinsic risks/benefits
.
🩺👀👉🏻Some of the original images from a doc you should follow: ‪@Yourheartdoc‬
.
#Cardiology #Medicine #MedSchool #DocsOfInstagram #TikTokDoc #NursingTips #MedSchoolTips #InterventionalCardiology #Nurses #NursingSchool #NursingStudent #MedicineExplained #echocardiography #premed #PreMedTips