Patient Management, Protected PCI
SmartAssist® Facilitates Impella® Weaning and Explant Decision Making
Rajan Patel, MD, FACC, FAHA, FSCAI discusses how SmartAssist technology has helped him make decisions about explanting and weaning in his high-risk PCI cases. Dr. Patel is an interventional cardiologist at Ochsner Medical Center.
Dr. Patel describes a subset of Protected PCI patients, including those with acute coronary syndromes or very low ejection fraction, who appear hemodynamically stable at the end of the case but are not. “You think you can explant Impella and everything’s going to be fine,” he tells interviewer Seth Bilazarian, MD. “Then 2 hours later, you get called back to the cardiac ICU because the patient doesn’t look well. You check a mixed venous saturation and it’s 30-something and you sort of kick yourself, wondering why did you take the Impella out.”
Dr. Patel explains how SmartAssist, along with Impella Connect®, allows assessment of the patient during Impella weaning in the cath lab. He finds the ability to look at native cardiac output, Impella-provided cardiac output, total cardiac output, and trends, particularly useful. “Even though the patient may look hemodynamically stable, if the native cardiac output is not increasing as the Impella-provided cardiac output is being decreased, that could be a flag or a sign of something going on.”
Dr. Patel also appreciates that the Impella Connect® system and SmartAssist technology allow him to look at left ventricular end-diastolic pressure (LVEDP). “If that LVEDP is higher at the end of the case than it was at the beginning of the case, that’s perhaps a flag that you may be heading for some trouble. And it may be worth considering leaving the Impella in overnight.”
Dr. Patel also tells Dr. Bilazarian that the technical aspects of the case, that is, what he actually did to the patient, and the hemodynamic response to what he did, figure into his weaning strategies for high-risk PCI patients. He emphasizes the importance of weaning decision making. “If one were to explant the Impella prematurely in the cath lab and the patient goes into cardiogenic shock in the cardiac ICU post-procedure, then 1. It’s a determent to the patient’s health, and 2. You’ve increased the length of stay for that patient and that’s not something that can be taken lightly.”