Clinical management of select patients with surgically implanted Impella 5.5 left ventricular assist devices on a cardiovascular step-down unit
Abstract Body (Do not enter title and authors here): Introduction: Surgically implanted Impella 5.5 percutaneous left ventricular assist device utilization is increasing. Most centers manage Impella 5.5 patients exclusively in the ICU; however, there are concerns regarding prolonged ICU bed utilization in clinically stable patients. This study evaluates our experience managing Impella 5.5 patients in a stepdown unit (SDU).
Methods: In January 2023, select patients with Impella 5.5 at our institution were admitted to a SDU after ≥24 hours in the ICU post implant. Eligible patients had no significant bleeding, device issues, or ongoing hypoperfusion. Demographics, hemodynamics, outcomes, and adverse events (Fig) were collected retrospectively and adjudicated by multidisciplinary clinician review.
Results: Between Jan 1, 2023 and Mar 31, 2024, a total of 64 patients with Impella 5.5 were managed at our institution. Of these, 42 (66%) were managed in SDU for a median (IQR) of 11 (7, 21) days (range 1-82), totaling 733 of 1055 (69%) Impella-days. SDU patients with Impella 5.5 had a median age of 60 (50, 63) years, were mostly male (55%), non-ischemic (79%), and presented with Stage C (52%) or D (43%) shock. Impella strategy in SDU patients was bridge to transplant in 60% (n=25), to decision in 31% (n=13), to durable LVAD in 8% (n=3), and for VT ablation support in 1% (n=1). Five (12%) patients required transfer back to the ICU for escalation of care.
Impella 5.5 patients on SDU experienced a total of 28 adverse events (0.027 events per Impella-day), with >1 adverse event in 16/42 (38%) patients (Fig). Twenty-eight (67%) SDU patients underwent heart transplant and 10 (24%) underwent LVAD implant during the hospitalization. One patient died during their hospital course, in whom care was withdrawn due to lack of a destination option.
Conclusions: For select patients with Impella 5.5 who met institutional criteria, transfer to a SDU was feasible and safe. This strategy may increase ICU throughput and optimize resource allocation.
Ospina, Meg
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Bull, Lindsey
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Inampudi, Chakradhari
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Mcmurray, Jeff
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Tedford, Ryan
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Witer, Lucas
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Bhandari, Krishna
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Yourshaw, Jeffrey
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Houston, Brian
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Kilic, Arman
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Carnicelli, Anthony
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Griffin, Jan
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Van Bakel, Adrian
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Jackson, Gregory
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Rao, Vishal N.
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Atkins, Jessica
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Hajj, Jennifer
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Dodson, Kaylen
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Summer, Mary Kathryn
( Medical University of South Carolina
, Charleston
, South Carolina
, United States
)
Author Disclosures:
Meg Ospina:DO NOT have relevant financial relationships
| Lindsey Bull:DO NOT have relevant financial relationships
| Chakradhari Inampudi:DO NOT have relevant financial relationships
| Jeff McMurray:DO NOT have relevant financial relationships
| Ryan Tedford:DO have relevant financial relationships
;
Consultant:Abbott:Active (exists now)
; Consultant:Merck:Active (exists now)
; Advisor:Abiomed:Active (exists now)
; Consultant:Endotronix:Active (exists now)
; Consultant:United Therapeutics:Active (exists now)
; Consultant:Restore Medical:Active (exists now)
; Consultant:Morphic Therapeutics:Active (exists now)
; Consultant:Medtronic:Active (exists now)
; Consultant:Gradient:Active (exists now)
; Consultant:Edwards LifeSciences:Active (exists now)
; Consultant:Cytokinetics:Past (completed)
; Consultant:Boston Scientific:Active (exists now)
; Consultant:Alleviant:Past (completed)
; Individual Stocks/Stock Options:Aria CV:Active (exists now)
; Consultant:Acorai:Active (exists now)
| Lucas Witer:DO NOT have relevant financial relationships
| Krishna Bhandari:DO NOT have relevant financial relationships
| JEFFREY YOURSHAW:No Answer
| Brian Houston:DO NOT have relevant financial relationships
| Arman Kilic:DO have relevant financial relationships
;
Consultant:abiomed:Active (exists now)
; Consultant:livanova:Past (completed)
; Consultant:3ive:Past (completed)
; Consultant:abbott:Active (exists now)
| Anthony Carnicelli:DO have relevant financial relationships
;
Researcher:Acorai:Active (exists now)
| Jan Griffin:No Answer
| Adrian Van Bakel:DO have relevant financial relationships
;
Research Funding (PI or named investigator):CVRx:Past (completed)
; Research Funding (PI or named investigator):AskBio/Bayer:Active (exists now)
; Research Funding (PI or named investigator):CareDx:Active (exists now)
| Gregory Jackson:DO NOT have relevant financial relationships
| Vishal N. Rao:No Answer
| Jessica Atkins:DO NOT have relevant financial relationships
| Jennifer Hajj:DO have relevant financial relationships
;
Speaker:Abbott:Active (exists now)
; Speaker:Medtronic:Active (exists now)
| Kaylen Dodson:DO NOT have relevant financial relationships
| Mary Kathryn Summer:No Answer
