AINS Anästhesiologie · Intensivmedizin · Notfallmedizin · Schmerztherapie, Thieme Verlag Heft 5-2023, Jahrgang 58) ISSN 1439-1074 Seite(n) 304 bis 320 DOI: 10.1055/a-1859-0105 CareLit-Dokument-Nr: 318600 |
|
Der Einsatz der verschiedenen Impella-Typen ist mittlerweile in der klinischen Routine in ganz unterschiedlichen Bereichen fest etabliert. Neben der hämodynamischen Unterstützung während High-Risk-perkutanen Koronarinterventionen oder verschiedener kardiochirurgischer Operationen wird die Impella allein oder in Kombination mit extrakorporalen Life-Support-Systemen regelhaft bei Patienten im kardiogenen Schock eingesetzt. Abstract The use of temporary mechanical circulatory support (tMCS) devices and in particular the increasing use of the Impella device family has gained significant interest over the last two decades. Nowadays, its use plays a well-established key role in both the treatment of cardiogenic shock, and as a preventive and protective therapeutic option during high-risk procedures in both cardiac surgery and cardiology, such as complex percutaneous interventions (protected PCI). Thus, it is not surprising that the Impella device is more and more present in the perioperative setting and especially in patients on intensive care units. Despite the numerous advantages such as cardiac resting and hemodynamic stabilization, potential adverse events exist, which may lead to severe, but preventable complications, so that adequate education, early recognition of such events and a subsequent adequate management are crucial in patients with tMCS. This article provides an overview especially for anesthesiologists and intensivists focusing on technical basics, indications and contraindications for its use with special focus on the intra- and postoperative management. Furthermore, troubleshooting for most common complications for patients on Impella support is provided. Kernaussagen Die Verwendung von temporären mechanischen Kreislaufunterstützungssystemen (tMCS) und insbesondere der zunehmende Einsatz der Impella-Device-Familie hat in den letzten 2 Jahrzehnten großes Interesse geweckt. Heutzutage spielt ihre Verwendung eine etablierte Schlüsselrolle sowohl bei der Behandlung des kardiogenen Schocks als auch als präventive und protektive Therapieoption bei risikoreichen Eingriffen sowohl in der Herzchirurgie als auch in der Kardiologie, z. B. bei komplexen perkutanen Eingriffen. So ist es nicht verwunderlich, dass der Einsatz einer Impella-Unterstützung immer häufiger im perioperativen Setting und insbesondere bei Patienten auf Intensivstationen beobachtet wird. Trotz der zahlreichen Vorteile wie kardialer Erholung und hämodynamischer Stabilisierung sind potenziell unerwünschte Ereignisse zu bedenken, die zu schweren, aber vermeidbaren Komplikationen führen können. Eine angemessene Aufklärung, frühzeitige Erkennung solcher Ereignisse und anschließende adäquate Behandlung bei Patienten mit tMCS sind entscheidend. Dieser Beitrag bietet einen Überblick speziell für Anästhesisten und Intensivmediziner mit Schwerpunkt auf technischen Grundlagen, Indikationen und Kontraindikationen für die Anwendung mit besonderem Fokus auf das intra- und postoperative Management. Darüber hinaus wird das Management für die häufigsten Komplikationen bei Patienten mit Impella-Unterstützung beschrieben. Schlüsselwörter Impella - mechanische Kreislaufunterstützung - kardiogener Schock - protected PCI - intensivmedizinisches Management Keywords impella - mechanical circulatory support - cardiogenic shock - protected PCI - critical care management 16 May 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany Literatur 1 Werner N, Akin I, Al-Rashid F. et al. Expertenkonsensus zum praktischen Einsatz von Herzkreislaufunterstützungssystemen bei Hochrisiko-Koronarinterventionen. Kardiologe 2017; 11: 460-472 DOI: 10.1007/s12181-017-0208-3. CrossrefPubMedGoogle Scholar 2 Manian N, Thakker J, Nair A. The Use of Mechanical Circulatory Assist Devices for ACS Patients with Cardiogenic Shock and High-Risk PCI. Curr Cardiol Rep 2022; 24: 699-709 DOI: 10.1007/s11886-022-01688-3. (PMID: 35403950) CrossrefPubMedGoogle Scholar 3 Schrage B, Becher PM, Goßling A. et al. Temporal trends in incidence, causes, use of mechanical circulatory support and mortality in cardiogenic shock. ESC Heart Fail 2021; 8: 1295-1303 DOI: 10.1002/ehf2.13202. (PMID: 33605565) CrossrefPubMedGoogle Scholar 4 McDonagh TA, Metra M, Adamo M. et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021; 42: 3599-3726 DOI: 10.1093/eurheartj/ehab368. (PMID: 34447992) CrossrefPubMedGoogle Scholar 5 Heidenreich PA, Bozkurt B, Aguilar D. et al. 2022 AHA/ACC/HFSA Guideline for the Management of Heart Failure: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol 2022; 79: e263-e421 DOI: 10.1016/j.jacc.2021.12.012. (PMID: 35363500) CrossrefPubMedGoogle Scholar 6 O’Neill WW, Schreiber T, Wohns DHW. et al. The current use of Impella 2.5 in acute myocardial infarction complicated by cardiogenic shock: results from the USpella Registry. J Interv Cardiol 2014; 27: 1-11 DOI: 10.1111/joic.12080. CrossrefPubMedGoogle Scholar 7 Curran J, Burkhoff D, Kloner RA. Beyond reperfusion: acute ventricular unloading and cardioprotection during myocardial infarction. J Cardiovasc Transl Res 2019; 12: 95-106 DOI: 10.1007/s12265-019-9863-z. (PMID: 30671717) CrossrefPubMedGoogle Scholar 8 O’Neill WW, Kleiman NS, Moses J. et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012; 126: 1717-1727 DOI: 10.1161/CIRCULATIONAHA.112.098194. CrossrefPubMedGoogle Scholar 9 Wollmuth J, Patel MP, Dahle T. et al. Ejection Fraction Improvement Following Contemporary High-Risk Percutaneous Coronary Intervention: RESTORE EF Study Results. J Soc Cardiovasc Angiogr Interv 2022; 1: 100350 DOI: 10.1016/j.jscai.2022.100350. CrossrefPubMedGoogle Scholar 10 Schrage B, Becher PM, Bernhardt A. et al. Left ventricular unloading is associated with lower mortality in patients with cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: results from an international, multicenter cohort study. Circulation 2020; 142: 2095-2106 DOI: 10.1161/CIRCULATIONAHA.120.048792. CrossrefPubMedGoogle Scholar 11 Kowalewski M, Malvindi PG, ZieliÅski K. et al. Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis. J Clin Med 2020; 9: 1039 DOI: 10.3390/jcm9041039. CrossrefPubMedGoogle Scholar 12 Lorusso R, Meani P, Raffa GM. et al. Extracorporeal membrane oxygenation and left ventricular unloading: What is the evidence?. JTCVS Techniques 2022; 13: 101-114 DOI: 10.1016/j.xjtc.2022.02.039. CrossrefPubMedGoogle Scholar 13 Crowley J, Cronin B, Essandoh M. et al. Transesophageal echocardiography for impella placement and management. J Cardiothorac Vasc Anesth 2019; 33: 2663-2668 DOI: 10.1053/j.jvca.2019.01.048. (PMID: 30770179) CrossrefPubMedGoogle Scholar 14 Pieri M, Pappalardo F. Bedside insertion of impella percutaneous ventricular assist device in patients with cardiogenic shock. Int J Cardiol 2020; 316: 26-30 DOI: 10.1016/j.ijcard.2020.05.080. (PMID: 32473286) CrossrefPubMedGoogle Scholar 15 Ott S, Lanmüller P, Nersesian G. et al. Management of increased systemic flow requirements in patients with left ventricular assist devices. Ann Cardiothorac Surg 2021; 10: 399-401 DOI: 10.21037/acs-2021-cfmcs-37. CrossrefPubMedGoogle Scholar 16 Eulert-Grehn J-J, Starck C, Kempfert J. et al. ECMELLA 2.0: single arterial access technique for a staged approach in cardiogenic shock. Ann Thorac Surg 2021; 111: e135-e137 DOI: 10.1016/j.athoracsur.2020.06.084. (PMID: 32918864) CrossrefPubMedGoogle Scholar 17 Rohm CL, Gadidov B, Ray HE. et al. Vasopressors and inotropes as predictors of mortality in acute severe cardiogenic shock treated with the impella device. Cardiovasc Revasc Med 2021; 31: 71-75 DOI: 10.1016/j.carrev.2020.12.001. CrossrefPubMedGoogle Scholar 18 Basir MB, Kapur NK, Patel K. et al. Improved Outcomes Associated with the use of Shock Protocols: Updates from the National Cardiogenic Shock Initiative. Catheter Cardiovasc Interv 2019; 93: 1173-1183 DOI: 10.1002/ccd.28307. CrossrefPubMedGoogle Scholar 19 Levy B, Clere-Jehl R, Legras A. et al. Epinephrine Versus Norepinephrine for Cardiogenic Shock After Acute Myocardial Infarction. J Am Coll Cardiol 2018; 72: 173-182 DOI: 10.1016/j.jacc.2018.04.051. (PMID: 29976291) CrossrefPubMedGoogle Scholar 20 O’Neill WW, Grines C, Schreiber T. et al. Analysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device. Am Heart J 2018; 202: 33-38 DOI: 10.1016/j.ahj.2018.03.024. CrossrefPubMedGoogle Scholar 21 Saxena A, Garan AR, Kapur NK. et al. Value of hemodynamic monitoring in patients with cardiogenic shock undergoing mechanical circulatory support. Circulation 2020; 141: 1184-1197 DOI: 10.1161/CIRCULATIONAHA.119.043080. CrossrefPubMedGoogle Scholar 22 Ott S, Nersesian G, Spillmann F. et al. Temporäre mechanische Kreislaufunterstützung auf der Intensivstation – Management, Komplikationen und Weaning. Herzmedizin 2022; 38: x59-x66 PubMedGoogle Scholar 23 Lorusso R, Barili F, Mauro MD. et al. In-Hospital Neurologic Complications in Adult Patients Undergoing Venoarterial Extracorporeal Membrane Oxygenation: Results From the Extracorporeal Life Support Organization Registry. Crit Care Med 2016; 44: e964-e972 DOI: 10.1097/CCM.0000000000001865. CrossrefPubMedGoogle Scholar 24 Burzotta F, Trani C, Doshi SN. et al. Impella ventricular support in clinical practice: Collaborative viewpoint from a European expert user group. Int J Cardiol 2015; 201: 684-691 DOI: 10.1016/j.ijcard.2015.07.065. CrossrefPubMedGoogle Scholar 25 Vandenbriele C, Arachchillage DJ, Frederiks P. et al. Anticoagulation for Percutaneous Ventricular Assist Device-Supported Cardiogenic Shock: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79: 1949-1962 DOI: 10.1016/j.jacc.2022.02.052. (PMID: 35550692) CrossrefPubMedGoogle Scholar 26 Beckmann A, Benk C, Beyersdorf F. et al. Position article for the use of extracorporeal life support in adult patients. Eur J Cardiothorac Surg 2011; 40: 676-680 DOI: 10.1016/j.ejcts.2011.05.011. (PMID: 21683610) CrossrefPubMedGoogle Scholar 27 Beavers CJ, DiDomenico RJ, Dunn SP. et al. Optimizing anticoagulation for patients receiving Impella support. Pharmacotherapy 2021; 41: 932-942 DOI: 10.1002/phar.2629. (PMID: 34597429) CrossrefPubMedGoogle Scholar 28 Abbasciano RG, Yusuff H, Vlaar APJ. et al. Blood Transfusion Threshold in Patients Receiving Extracorporeal Membrane Oxygenation Support for Cardiac and Respiratory Failure - A Systematic Review and Meta-Analysis. J Cardiothorac Vasc Anesth 2021; 35: 1192-1202 DOI: 10.1053/j.jvca.2020.08.068. (PMID: 33046363) CrossrefPubMedGoogle Scholar 29 Cavayas YA, Del Sorbo L, Fan E. Intracranial hemorrhage in adults on ECMO. Perfusion 2018; 33: 42-50 DOI: 10.1177/0267659118766435. (PMID: 29788836) CrossrefPubMedGoogle Scholar 30 Ouweneel DM, de Brabander J, Karami M. et al. Real-life use of left ventricular circulatory support with Impella in cardiogenic shock after acute myocardial infarction: 12 years AMC experience. Eur Heart J Acute Cardiovasc Care 2019; 8: 338-349 DOI: 10.1177/2048872618805486. CrossrefPubMedGoogle Scholar
{{detailinfo.data.api.data.document[0].apa}}
{{detailinfo.data.api.data.document[0].vancouver}}
{{detailinfo.data.api.data.document[0].harvard}}