Published: June 12th, 2021
Percutaneous ventricular assist devices are increasingly being utilized in patients with acute myocardial infarction and cardiogenic shock. Herein, we discuss the mechanism of action and hemodynamic effects of such devices. We also review algorithms and best practices for the implantation, management and weaning of these complex devices.
Cardiogenic shock is defined as persistent hypotension, accompanied by evidence of end organ hypo-perfusion. Percutaneous ventricular assist devices (PVADs) are used for the treatment of cardiogenic shock in an effort to improve hemodynamics. Impella is currently the most common PVAD and actively pumps blood from the left ventricle into the aorta. PVADs unload the left ventricle, increase cardiac output and improve coronary perfusion. PVADs are typically placed in the cardiac catheterization laboratory under fluoroscopic guidance via the femoral artery when feasible. In cases of severe peripheral arterial disease, PVADs can be implanted through an alternative access. In this article, we summarize the mechanism of action of PVAD and the data supporting their use in the treatment of cardiogenic shock.
Cardiogenic shock (CS) is defined as persistent hypotension (systolic blood pressure <90 mmHg for >30 minutes, or the need for vasopressors or inotropes), end-organ hypo-perfusion (urine output <30 mL/h, cool extremities or lactate > 2 mmol/L), pulmonary congestion (pulmonary capillary wedge pressure (PCWP) ≥ 15 mmHg) and decrease cardiac performance (cardiac index <2.2 )1,2 due to a primary cardiac disorder. Acute myocardial infarction (AMI) is the most common cause of CS3<....
This protocol is the standard of care in our institution.
1. Insertion of the PVAD (e.g., Impella CP)
Table 1 shows the safety and efficacy of PVAD implantation35,36,37,38,39,40.
Optimizing PVAD Outcomes
PVADs are a resource-heavy intervention that requires significant experience and expertise to optimize outcomes. The following best practices should be consi.......
Minimizing the Risks and Complications of PVAD (Table 2)
The hemodynamic benefits of PVAD can be significantly neutralized if complications from large-bore access occur, such as major bleeding and acute limb ischemia28,29. It is thus essential to minimize the risk and complications of the device.
In order to decrease access site complications and reduce the number of access attempts, ultrasound and fluoroscopic g.......
|4 Fr-018-10 cm Silhouette Stiffened Micropuncture Set
|5 Fr Infiniti Pigtail Catheter
|Impella CP Intra-cardiac Assist Catheter
|Impella catheter kit
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