Cardiovascular Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan
Cardiovascular Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Shizuoka, Japan.
BMJ Case Rep. 2023 Dec 21;16(12):e255462. doi: 10.1136/bcr-2023-255462.
A man in his 40s with ST-segment elevation myocardial infarction complicating cardiogenic shock was transferred to our hospital. Emergent percutaneous coronary intervention for the left anterior descending and left circumflex arteries supported with Impella CP was performed. However, his cardiac function was severely impaired, and anuria developed, necessitating continuous renal replacement therapy (CRRT). After Impella CP was removed on day 6, the patient remained dependent on inotropes and CRRT. Following volume reduction to manage pulmonary congestion, symptoms of low perfusion appeared. Then, Impella 5.5 was inserted on day 38 as a bridge to decision. On day 52, the urine volume reached >2000 mL/day, and CRRT was discontinued. On day 56, the patient was transferred to a certified facility for left ventricular assist device implantation or heart transplantation. This case suggests the potential of Impella 5.5 as a bridge to decision in patients with organ failure caused by low cardiac output.
一位 40 多岁的男性因心原性休克并发 ST 段抬高型心肌梗死被转至我院。紧急行经皮冠状动脉介入治疗左前降支和左回旋支，并使用 Impella CP 支持。然而，他的心脏功能严重受损，出现无尿，需要持续肾脏替代治疗（CRRT）。第 6 天 Impella CP 被移除后，患者仍然依赖于正性肌力药物和 CRRT。在容量减少以管理肺充血后，出现低灌注症状。随后，第 38 天插入 Impella 5.5 作为决策桥。第 52 天，尿量达到 >2000 mL/天，停止 CRRT。第 56 天，患者被转至认证机构，准备进行左心室辅助装置植入或心脏移植。该病例提示 Impella 5.5 可能成为因心输出量低导致器官衰竭患者的决策桥。
