Mechanical life support algorithm for the emergency management of patients with left-sided Impella.

ABSTRACT

We sought to remedy the limited guidance that is available to support the resuscitation of patients with the Impella Cardiac Power (CP) and 5.0 devices during episodes of cardiac arrest or life-threatening events that can result in haemodynamic decompensation. In a specialist tertiary referral centre we developed, by iteration, a novel resuscitation algorithm for Impella emergencies, which we validated through simulation and assessment by our multi- disciplinary team. A mechanical life support course was established to provide theoretical and practical education, combined with simulation to consolidate knowledge and confidence in algorithm use. We assessed these measures using confidence scoring, a key performance indicator (the time taken to resolve a suction event) and a multiple-choice question (MCQ) examination. Following this intervention, median confidence score increased from 2 (interquartile range [IQR] 2 to 3) to 4 (IQR 4 to 4) out of a maximum of 5 (n=53, p<0.0001). Theoretical knowledge of the Impella, as assessed by median MCQ score, increased from 12 (IQR 10 to 13) to 13 (12 to 14) out of a maximum of 17 (p<0.0001). The use of a bespoke Impella resuscitation algorithm reduced the mean time taken to identify and resolve a suction event by 53 seconds (95% confidence interval 36 to 99, p=0.0003). In conclusion, we present an evidence-based resuscitation algorithm that provides both technical and medical guidance to clinicians responding to life-threatening events in Impella recipients.