Intensive Care Unit Department, Western Health, Melbourne, Vic, Australia.
Department of Cardiology, Western Health, Melbourne, Vic, Australia.
Heart Lung Circ. 2024 Apr;33(4):460-469. doi: 10.1016/j.hlc.2023.12.007. Epub 2024 Feb 22.
The Impella (Abiomed, Danvers, MA, USA) temporary percutaneous left ventricular assist device is increasingly used as mechanical circulatory support in patients with acute myocardial infarction-cardiogenic shock (AMICS) or those undergoing high-risk protected percutaneous coronary intervention (PCI). The optimal weaning regimen remains to be defined.
We implemented a structured weaning protocol in a series of 10 consecutive patients receiving Impella support for protected PCI or AMICS treated with PCI in a high volume non-cardiac surgery centre. Weaning after revascularisation was titrated to native heart recovery using both haemodynamic and echocardiographic parameters.
Ten patients (eight male, two female; aged 43-70 years) received Impella support for AMICS (80%) or protected PCI (20%). Cardiogenic shock was of Society for Cardiac Angiography & Interventions grade C-E of severity in 80%, and median left ventricular end-diastolic pressure was 31 mmHg. Protocol implementation allowed successful weaning in eight of 10 patients with a median support time of 29 hours (range, 4-48 hours). Explantation was associated with an increase in heart rate (81 vs 88 bpm; p=0.005), but no significant change in Cardiac Index (2.9 vs 2.9 L/min/m), mean arterial pressure (79 vs 82 mmHg), vasopressor requirement (10% vs 10%), or serum lactate (1.0 vs 1.0). Median durations of intensive care and hospital stay were 3 and 6 days, respectively. At 30 days, the mortality rate was 20%, with median left ventricular ejection fraction of 40%.
A structured and dynamic weaning protocol for patients with AMICS and protected PCI supported by the Impella device is feasible in a non-cardiac surgery centre. Larger studies are needed to assess generalisability of such a weaning protocol.
Impella（Abiomed，马萨诸塞州丹弗斯）临时经皮左心室辅助装置越来越多地用于急性心肌梗死合并心原性休克（AMICS）或接受高危保护经皮冠状动脉介入治疗（PCI）的患者的机械循环支持。最佳撤机方案仍有待确定。
我们在一家高容量非心脏手术中心对接受 Impella 支持的接受保护 PCI 或 AMICS 治疗的 10 例连续患者实施了一项结构化撤机方案。使用血流动力学和超声心动图参数对再血管化后的心脏恢复情况进行滴定以达到撤机。
10 例患者（8 例男性，2 例女性；年龄 43-70 岁）因 AMICS（80%）或保护 PCI（20%）接受 Impella 支持。心原性休克的严重程度为心血管造影与介入学会（Society for Cardiac Angiography & Interventions）分级 C-E 级的患者占 80%，左心室舒张末期压中位数为 31mmHg。该方案的实施使 10 例患者中的 8 例成功撤机，中位支持时间为 29 小时（范围 4-48 小时）。撤机时，心率从 81 增加到 88 bpm（p=0.005），但心指数（2.9 升/分钟/米）、平均动脉压（79 毫米汞柱）、血管加压素需求（10%）或血清乳酸（1.0）没有明显变化。重症监护和住院时间中位数分别为 3 天和 6 天。30 天时死亡率为 20%，左心室射血分数中位数为 40%。
Impella 装置支持的 AMICS 和保护 PCI 患者的结构化和动态撤机方案在非心脏手术中心是可行的。需要更大规模的研究来评估这种撤机方案的普遍性。
