PMID- 36450558
OWN - NLM
STAT- MEDLINE
DCOM- 20221202
LR  - 20221202
IS  - 1349-3299 (Electronic)
IS  - 1349-2365 (Linking)
VI  - 63
IP  - 6
DP  - 2022
TI  - Impella Motor Current Amplitude Reflects the Degree of Left Ventricular Unloading 
      under ECPELLA Support.
PG  - 1187-1193
LID - 10.1536/ihj.22-237 [doi]
AB  - The combination of venoarterial extracorporeal membrane oxygenation (VA-ECMO) and 
      Impella, referred to as ECPELLA, is a powerful transient mechanical circulatory 
      support for patients with severe cardiogenic shock (CS). During ECPELLA support, 
      VA-ECMO loads the left ventricle (LV) and Impella unloads the LV. Therefore, 
      evaluating the degree of LV unloading during ECPELLA may be a prerequisite to 
      protect the injured myocardium. Here we report a patient with CS due to an 
      inferior ST-elevation myocardial infarction in which the degree of LV unloading 
      on ECPELLA was confirmed by direct LV pressure (LVP) measurement. After the 
      percutaneous coronary intervention for the right coronary artery on ECPELLA, the 
      aortic pressure became nonpulsatile and the peak systolic LVP was reduced at 
      approximately 10 mmHg with 20 mA of the Impella motor current (MC) amplitude, 
      which we referred to as the total LV unloading condition. We maintained the 
      condition in the early phase of ECPELLA by monitoring the Impella MC amplitude at 
      20 mA and less with nonpulsatile aortic pressure. The patient was successfully 
      weaned off VA-ECMO on day 3, and Impella was explanted on day 8. Prior to the 
      Impella explant, the Impella MC amplitude increased more than 100 mA and the 
      estimated pressure gradient between the aortic pressure and LVP was well matched 
      with the directly measured LVP. In this case, the patient was successfully 
      treated by ECPELLA with the total LV unloading condition, and we showed that the 
      degree of LV unloading on ECPELLA can be estimated from the aortic pressure and 
      Impella MC amplitude at given Impella flows.
FAU - Unoki, Takashi
AU  - Unoki T
AD  - Department of Intensive Care Medicine, Saiseikai Kumamoto Hospital.
FAU - Saku, Keita
AU  - Saku K
AD  - Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular 
      Center Research Institute.
FAU - Kametani, Motoko
AU  - Kametani M
AD  - Department of Intensive Care Medicine, Saiseikai Kumamoto Hospital.
FAU - Konami, Yutaka
AU  - Konami Y
AD  - Department of Intensive Care Medicine, Saiseikai Kumamoto Hospital.
FAU - Taguchi, Eiji
AU  - Taguchi E
AD  - Department of Cardiovascular Medicine, Saiseikai Kumamoto Hospital.
FAU - Sawamura, Tadashi
AU  - Sawamura T
AD  - Department of Intensive Care Medicine, Saiseikai Kumamoto Hospital.
FAU - Nakao, Koichi
AU  - Nakao K
AD  - Department of Cardiovascular Medicine, Saiseikai Kumamoto Hospital.
FAU - Sakamoto, Tomohiro
AU  - Sakamoto T
AD  - Department of Cardiovascular Medicine, Saiseikai Kumamoto Hospital.
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - Japan
TA  - Int Heart J
JT  - International heart journal
JID - 101244240
SB  - IM
MH  - Humans
MH  - *Heart Ventricles
MH  - Shock, Cardiogenic/therapy
MH  - *Extracorporeal Membrane Oxygenation
MH  - Systole
MH  - Myocardium
OTO - NOTNLM
OT  - AoP-LVP pressure gradient
OT  - Cardiogenic shock
OT  - Catheter-type heart pump
OT  - Total LV unloading
OT  - VA-ECMO
EDAT- 2022/12/01 06:00
MHDA- 2022/12/03 06:00
CRDT- 2022/11/30 21:14
PHST- 2022/11/30 21:14 [entrez]
PHST- 2022/12/01 06:00 [pubmed]
PHST- 2022/12/03 06:00 [medline]
AID - 10.1536/ihj.22-237 [doi]
PST - ppublish
SO  - Int Heart J. 2022;63(6):1187-1193. doi: 10.1536/ihj.22-237.