Impella Education, Patient Management, Protected PCI
Weaning with the SmartAssist® Technology Trend Screen
This video explains how to use the SmartAssist trend screen during weaning of the Impella® heart pump. Jessica Page, an advanced Impella® trainer with Abiomed, describes the metrics displayed on the screen and how they can inform clinical decisions regarding weaning.
To access the trend screen, press the DISPLAY soft key on the Automated Impella Controller™ (AIC) and select LVEDP/CO Trend. Keep in mind that the LV metrics are only available at performance levels of P-4 and higher and that cardiac output must be entered every 8 hours. In addition, the trend screen is for informational purposes only and patient hemodynamics should be verified using approved diagnostic devices.
The red placement signals box on the trend screen displays mean arterial pressure (Mean Ao, or MAP) and LV load (LVEDP) trends over time. Below that, the yellow box provides a breakdown of cardiac output. After a reference cardiac output is entered, the console displays the contribution from the Impella pump (green waveform) and the estimated native heart contribution (white waveform) to total cardiac output (yellow waveform). The trends can be viewed in increments of 15 minutes, 1 hour, 8 hours, and 12 hours.
When a patient is ready to be weaned, consider patient presentation and current condition. Then use the trending metrics while weaning the patient from Impella to assist decision making.
Look for stable MAP and LVEDP
Assess native heart recovery
Maintain overall cardiac output
When you look at the MAP and LVEDP trends, you want to see that these trends remain stable as you reduce Impella support. In the cardiac output portion of the trend screen, you want to see an increasing trend in native CO (white waveform) as Impella flow is decreasing (green waveform) and you want to see a stable trend in total CO (yellow waveform). The white native cardiac output waveform crossing and overtaking the green Impella flow waveform, while the overall CO remains stable, is a good indication that the patient is tolerating the reduction in support. Be sure to validate this with other diagnostic devices.
Potential signs of unsuccessful weaning may include increases or decreases in LVEDP and MAP trends, or a stable native cardiac output trend and decreasing total cardiac output as you reduce Impella flow. These trends may be indicators that the patient is not ready to be weaned off Impella support.
For more information, contact your local Abiomed team or the Clinical Support Center at 1-800-422-8666.