Improving Outcomes in Cardiogenic Shock Through Best Practices
Prior to discharge from the cath lab and in the ICU, reassess hemodynamics via PA catheter. Best practices include measuring cardiac power output (CPO) and pulmonary artery pulsatility index (PAPi) to evaluate the adequacy of left-sided Impella® support and right heart function, while reducing inotropes.
The AMI cardiogenic shock guidelines present criteria for ongoing patient assessment for myocardial recovery and weaning. If patients meet the criteria for myocardial recovery, wean and explant Impella after a minimum of 48 hours. If recovery is inadequate or there are no signs of recovery in the first 48 to 72 hours, consider escalation of care or transfer.
Patient Management Topics
Cardiogenic Shock Protocol
This download reviews cardiogenic shock guidelines and best practices for identifying, stabilizing, revascularizing and reassessing high-risk cardiogenic shock patients.
Increasing Survival in Cardiogenic Shock through Escalation
Mark Anderson, MD, discusses how cardiac surgery may be able to help achieve a ≥80% survival to discharge in the National Cardiogenic Shock Initiative (NCSI) Study.
Impella Patient Management in the CCU
Joseph Parrillo, MD, Brian Porvin, DO, Steven Keller, MD, PhD, and Seth Bilazarian, MD, discuss managing patients in the CCU with Impella.
Use the tool to calculate cardiac power output (CPO) and predict right ventricular failure following the implantation of an Impella left-side heart pump.
Heparin-Free Purge Solution
Sodium bicarbonate purge solution for Impella® heart pumps received FDA PMA approval in April 2022, as an alternative to heparin, for patients who are intolerant to heparin or in whom heparin is contraindicated (e.g. due to heparin-induced thrombocytopenia or bleeding).
Resources from the Education Library
Purge System Management Video Series
See how to change the purge cassette and purge fluid bag in these quick skills videos.
Assessing and Maintaining the Impella Access Site
Assessing the Impella access site and performing the suggested interventions can help prevent complications and improve patient outcomes.
Impella Management in the ICU
Viktoriya Kagan, AGACNP-BC, CCRN, and Eddy Gutierrez, MD, discuss how to care for patients with cardiogenic shock and manage Impella® in the ICU.