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.
Schlüsselwörter
Impella - mechanische Kreislaufunterstützung - kardiogener Schock - protected PCI
- intensivmedizinisches Management
Keywords
impella - mechanical circulatory support - cardiogenic shock - protected PCI - critical
care management
