Escalation with Impella Devices

Therapy Escalation

How Does Escalation Relate to Therapy Options Using Impella® Heart Pumps?

In the context of therapeutic options with Impella® heart pumps, "escalation" refers to the process of gradually increasing the level of support provided by the device in response to the patient's changing clinical needs.

Escalation may involve increasing the flow rate of the Impella device or adding additional devices to provide more comprehensive circulatory support. The goal of therapy escalation is to optimize hemodynamic support while minimizing the risk of complications associated with mechanical circulatory support.

Reasons for Escalation

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Impella 5.5® with SmartAssist® heart pump provides more forward flow to perfuse end organs and coronary arteries.

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Impella 5.5 with SmartAssist heart pump is able to fully unload the left ventricle.

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Impella 5.5 with SmartAssist heart pump is inserted through the axillary artery, allowing for patient ambulation.

Who Should Be Considered for Therapy Escalation?

Failing on Current Therapy

When determining who should be considered for therapy escalation, there are several factors to consider. One important consideration is whether the patient is failing on their current therapy. If a patient is not responding to their current treatment plan, it may be necessary to escalate their care.

Some specific signs that the current therapy is failing on the patient include continued or increasing inotropic therapy, decreasing urine output, and increasing lactate levels. These are all indicators that the patient's condition is worsening and that their current treatment plan may not be sufficient.

Large Body Surface Area (BSA) And Hemodynamic Deficit

Another factor to consider is the patient's hemodynamic status. Patients with a large body surface area or significant hemodynamic deficits may require escalation of care to address their condition effectively.

Quantitative Judgement

Quantitative judgement is also essential when considering escalation. Healthcare providers should consider the patient's cardiac output and the duration of their hemodynamic deficit. Additionally, calculating Cardiac Power Output (CO x MAP/451) and PAPi (PA systolic-PA diastolic/ RA) can provide additional information to guide the decision-making process.

Ultimately, the decision to escalate care is complex and requires careful consideration of all available information. Healthcare providers must weigh the risks and benefits of escalation to determine the best course of action for each patient.

Escalation, Weaning, and Transfer - Ongoing Monitoring is Key

Escalation, Weaning, and Transfer - Ongoing Monitoring is Key Escalation, Weaning, and Transfer - Ongoing Monitoring is Key

How to Benefit From Protocols for Escalation Strategies

Protocols provide a clear and standardized approach to managing patients who might require escalation of care. A protocol might lead to timely and appropriate decision-making when to escalate and how to do so. They help ensure that patients receive consistent and high-quality care and outline specific steps that healthcare providers could take in different scenarios. Protocols can help prevent errors or delays in care by providing clear guidelines for how to proceed. Learn more about protocols in terms of escalation strategies dealing with the determination of right vs. left side support and the determination of escalation, weaning, and transfer.

How to benefit from protocols for escalation therapy.

Utilizing CPO in Escalation Decision

This graph shows how utilizing the CPO can support making escalation decisions.


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