Tongers Jörn, Flierl Ulrike, Sieweke Jan-Thorben, Bauersachs Johann, Schäfer Andreas, Napp L Christian
Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Cardiovasc Revasc Med. 2019 Sep;20(9):827-828. doi: 10.1016/j.carrev.2018.12.006. Epub 2018 Dec 19.
Mechanical circulatory support with the Impella pump is established in many centers treating patients with cardiogenic shock. While Impella pumps usually run very stable, it may still be possible that one needs to remove the pump for using the same vascular access for different reasons. Unfortunately, until now it had been nearly impossible to remove the pump while preserving arterial access without severe bleeding. Here we describe a prototypical approach of exchanging an Impella pump in a 47-year-old female supported with veno-arterial ECMO for cardiogenic shock from myocarditis. The dysfunctional Impella pump was safely removed and replaced by a new one through the same arterial access site. Continuation of active LV unloading resolved pulmonary edema, and the patient was finally bridged to ventricular assist device surgery with favorable outcome. In general, the described approach is applicable for virtually all large-bore devices with arterial access.
在许多治疗心源性休克患者的中心，使用Impella泵进行机械循环支持已得到确立。虽然Impella泵通常运行非常稳定，但仍有可能因不同原因需要移除该泵以便利用相同的血管通路。不幸的是，到目前为止，在不发生严重出血的情况下保留动脉通路而移除泵几乎是不可能的。在此，我们描述了一种在一名47岁因心肌炎导致心源性休克而接受静脉-动脉体外膜肺氧合（ECMO）支持的女性患者中更换Impella泵的典型方法。功能失调的Impella泵通过相同的动脉通路部位被安全移除并更换为新泵。持续进行有效的左心室卸载解决了肺水肿问题，该患者最终成功过渡到心室辅助装置手术，结局良好。一般而言，所描述的方法实际上适用于所有具有动脉通路的大口径装置。
