E-46 | Bedside Removal of Impella Devices in Cardiogenic Shock Patients Is Feasible and Safe

Abstract

Patients with cardiogenic shock (CS) requiring mechanical circulatory support (MCS) are complex. The Impella CP (Abiomed, Danvers, MA) is a percutaneously placed left ventricular assist device and there is no established best-practice for device removal. Vascular complications from MCS devices are common and many patients undergo operative removal of these devices. To our knowledge there is no published data concerning the safety of bedside removal of femorally-placed Impella devices in the cardiovascular intensive care unit (CICU) for patients with CS. We conducted a retrospective chart review of all CS patients requiring MCS at our institution in 2020, approved by our institutional review board. In 2020 we cared for 84 patients requiring MCS in our CICU, excluding patients with intra-aortic balloon pumps. Of these, 55 patients had a femorally-placed Impella CP, either alone or with veno-arterial extracorporeal membrane oxygenation. 18 patients died with devices in place and three were transferred to another facility on MCS. 14 patients had their Impella removed in the operating room and five in the cardiac catheterization lab. 15 total patients (27%) underwent Impella removal at bedside in the CICU. Of the patients with bedside removal, a vascular closure device was used in the vast majority (87%). Only one patient had post-removal leg ischemia requiring surgical or endovascular intervention; this patient had preexisting peripheral vascular disease and the Impella was removed via manual pressure for clinical ischemia. Bedside removal of femorally-placed Impella CP devices is feasible and safe in select CS patients. More research is needed to establish best-practices for MCS device removal.