Comprehensive Unloading Strategy for Rapid Heart Recovery Under Support With Impella

• Published in: Curēus (Palo Alto, CA) Vol. 15; no. 9; p. e45590
• Main Authors: Yamamoto, Masayoshi, Ishizu, Tomoko, Minami, Kentaro, Tsuchiya, Ryosuke, Hiraya, Daigo
• Format: Journal Article
• Language: English
• Published: United States Cureus Inc 20.09.2023; Cureus
• Subjects: Cardiac arrhythmia; Cardiac function; Cardiology; Ejection fraction; Electrocardiography; Emergency Medicine; Extracorporeal membrane oxygenation; Heart failure; Heart rate; Hemodynamics; Hypotension; Patients; Pulmonary arteries; Radiography; Recovery (Medical); Thrombosis; Veins & arteries; Ventilation; impella; heart failure; cardiogenic shock; unloading; ivabradine
• ISSN: 2168-8184; 2168-8184
• DOI: 10.7759/cureus.45590

The establishment of a strategy for rapid heart recovery in patients with cardiogenic shock is required. Impella is a percutaneous left ventricular (LV) assist device that maintains hemodynamic stability and also causes LV mechanical unloading. However, the timing at which Impella should be started and a systematic strategy after the start of Impella have not been established. We report a representative case of dilated cardiomyopathy requiring catecholamines and intra-aortic balloon pumping (IABP). The hemodynamics were unstable under IABP support, and withdrawal from IABP or catecholamines was considered impossible. However, the exchange of the IABP with Impella CP made it possible to suppress the heart rate with ivabradine, introduce intensive heart failure medication, and discontinue catecholamines. The patient was weaned from Impella 24 days after the start of the first Impella CP. Rapid heart recovery was achieved with favorable outcomes. We present a comprehensive strategy for rapid heart recovery using Impella in a patient with cardiogenic shock.