How Alarming
This color alarm needs immediate action.
What is a red alarm?
Your Impella 5.5 is running at P8: 5.3LPM. ”Impella Position Unknown” alarm. Pt is awake, warm, wanting lunch. BP 101/99.
Impella 5.5 is fully unloading and supporting LV function.
This number will help you determine if the Impella catheter has moved.
What is centimeter marking?
This lab value is important to make sure clot does not form in the Impella.
What is PTT, ACT, or Anti XA?
In the patient, the inlet is positioned here
What is the Left Ventricle?
An alarm that is triggered when there is not enough volume in the LV.
What is suction?
Dr. asks if there were any Impella alarms overnight, but you haven’t gotten handoff yet.
What is Menu—> Alarm History?
The preferred additive to the purge solution.
What is Sodium Bicarbonate?
This lab value helps us determine tissue hypoperfusion
What is Lactate?
What is three point fixation?
Continued suction despite CVP >10 and good Impella position may indicate this.
What is Right Ventricular Failure?
Impella CP at P-9. Vaso 0.04, Levo 0.1, and Epi 0.06.
CPO 0.7. Q2 Lactate 12, 8.1, 7, 8.5.
What is escalate to Impella 5.5 or ECMO?
These two locks keep the Impella CP from moving.
What is T-Lock and tuohy-borst valve?
If this lab value is low, we might also have a suction alarm.
What is Hemoglobin/Hematocrit?
My AO placement signal (red waveform) is lower than my Art Line. Which one do I treat?
Always your art line or NIBP.
This alarm occurs when the Impella outlet is sitting at the level of the aortic valve. Or your patient is crashing.
What is “Placement Signal Low” alarm?
Patient arrives with Impella CP. The dressing is bloody and covered with tegaderm from groin to knee.
Redress. Angle of Entry Match. Occlusive dressing w/ ”shirt and pants”. Hold pressure if necessary.
This is the best way to verify Impella position in the heart.
What is Echo?
This value can tell us how well our patient is supported with current therapies and can help us differentiate shock types. Hint: “xx%”
What is a PA sat or SvO2?
(sPAP-dPAP)/RA.
What is PAPi?
Severe RV dysfunction <1.0
This red alarm occurs when Purge Flow drops <2ml/hr and Purge Pressure >1100mmHg.
What is “Purge Pressure High” alarm.
DAILY DOUBLE
BP: 90/48 (62), CO: 4.1, CI: 1.6
Dr. Loghmani asks, “What‘s your CPO?”
This part of your physical assessment is especially important w/ the Impella CP.
What is neurovascular assessment? Pain, Pallor, Paresthesia, Pulselessness, Paralysis
Patient is on day 2 of Impella CP support.
P9, flows 2.8L
BP120/100(106) CI 2.2
Vaso 0.04, Levo 0.08, Milrinone 0.25
Urine is red. LDH 1200. H/H/Plt trending down.
Complication? Treatment?
Hemolysis (*afterload sensitive)
MAP goal 65-75, wean vasopressors as tolerated
If a candidate, might consider impella 5.5 for more flow with decreased risk of hemolysis.
Right radial paO2 went from 115 to 53 with changes to ECMO/Impella therapies (ECMO 5.2L to 3.7; Impella P2 to P6). Name the syndrome and treatment.
What is North/South or Harlequin Syndrome?
Tx: Temporary fix- return to prior ECMO/Impella flows. Optimize ventilation and native oxygenation if possible.