Die Rolle der perkutanen Impella-Pumpe in der Anästhesie und Intensivmedizin

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.

Kernaussagen

• Die Verwendung von temporären mechanischen Kreislaufunterstützungssystemen (tMCS) und insbesondere der zunehmende Einsatz der Impella-Device-Familie hat in den letzten 2 Jahrzehnten großes Interesse geweckt.

• Heutzutage spielt ihre Verwendung eine etablierte Schlüsselrolle sowohl bei der Behandlung des kardiogenen Schocks als auch als präventive und protektive Therapieoption bei risikoreichen Eingriffen sowohl in der Herzchirurgie als auch in der Kardiologie, z. B. bei komplexen perkutanen Eingriffen.

• So ist es nicht verwunderlich, dass der Einsatz einer Impella-Unterstützung immer häufiger im perioperativen Setting und insbesondere bei Patienten auf Intensivstationen beobachtet wird.

• Trotz der zahlreichen Vorteile wie kardialer Erholung und hämodynamischer Stabilisierung sind potenziell unerwünschte Ereignisse zu bedenken, die zu schweren, aber vermeidbaren Komplikationen führen können. Eine angemessene Aufklärung, frühzeitige Erkennung solcher Ereignisse und anschließende adäquate Behandlung bei Patienten mit tMCS sind entscheidend.

• Dieser Beitrag bietet einen Überblick speziell für Anästhesisten und Intensivmediziner mit Schwerpunkt auf technischen Grundlagen, Indikationen und Kontraindikationen für die Anwendung mit besonderem Fokus auf das intra- und postoperative Management.

• Darüber hinaus wird das Management für die häufigsten Komplikationen bei Patienten mit Impella-Unterstützung beschrieben.

Schlüsselwörter

Impella - mechanische Kreislaufunterstützung - kardiogener Schock - protected PCI - intensivmedizinisches Management

Keywords

impella - mechanical circulatory support - cardiogenic shock - protected PCI - critical care management

Publication History

Article published online:
16 May 2023

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