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Borrelli G, Nittolo I, Bochicchio C, Trainelli L, Confalone V, Satta T, Cancani F, Kirk R, Amodeo A, Di Nardo M. What the pediatric nurse needs to know about the Impella cardiac assist device. Perfusion 2024; 39:95S-106S. [PMID: 38651583 PMCID: PMC11041080 DOI: 10.1177/02676591241237761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
Background: Cardiogenic shock in children still carries a high mortality risk despite advances in medical therapy. The use of temporary mechanical circulatory supports is an accepted strategy to bridge patients with acute heart failure to recovery, decision, transplantation or destination therapy. These devices are however limited in children and extracorporeal membrane oxygenation (ECMO) remains the most commonly used device. Veno-arterial ECMO may provide adequate oxygen delivery, but it does not significantly unload the left ventricle, and this may prevent recovery. To improve the likelihood of left ventricular recovery and minimize the invasiveness of mechanical support, the Impella axial pump has been increasingly used in children with acute heart failure in the last decade. Purpose: There are still limited data describing the Impella indications, management and outcomes in children, therefore, we aimed to provide a comprehensive narrative review useful for the pediatric nurses to be adequately trained and acquire specific competencies in Impella management.
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Affiliation(s)
- Giorgia Borrelli
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Ilaria Nittolo
- Academic Department of Pediatrics (DPUO), Immune and Infectious Diseases Division, Research Unit of Primary Immunodeficiencies, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Chiara Bochicchio
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Laura Trainelli
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Valerio Confalone
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Tiziana Satta
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Federica Cancani
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Richard Kirk
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Antonio Amodeo
- Heart Failure, Transplantation and Cardio-Respiratory Mechanical Assistance Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
| | - Matteo Di Nardo
- Pediatric Intensive Care Unit, Bambino Gesù Children’s Hospital, IRCCS, Rome, Italy
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Hirschhorn M, Throckmorton A. Pediatric mechanical circulatory support—leveraging design innovation for the younger generation. J Card Surg 2019; 35:8-10. [DOI: 10.1111/jocs.14266] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Matthew Hirschhorn
- From the BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems Drexel University Philadelphia
| | - Amy Throckmorton
- From the BioCirc Research Laboratory, School of Biomedical Engineering, Science, and Health Systems Drexel University Philadelphia
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Yarlagadda VV, Maeda K, Zhang Y, Chen S, Dykes JC, Gowen MA, Shuttleworth P, Murray JM, Shin AY, Reinhartz O, Rosenthal DN, McElhinney DB, Almond CS. Temporary Circulatory Support in U.S. Children Awaiting Heart Transplantation. J Am Coll Cardiol 2017; 70:2250-2260. [DOI: 10.1016/j.jacc.2017.08.072] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2017] [Revised: 08/29/2017] [Accepted: 08/29/2017] [Indexed: 10/18/2022]
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Chopski SG, Moskowitz WB, Stevens RM, Throckmorton AL. Mechanical Circulatory Support Devices for Pediatric Patients With Congenital Heart Disease. Artif Organs 2016; 41:E1-E14. [DOI: 10.1111/aor.12760] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2015] [Revised: 03/21/2016] [Accepted: 03/22/2016] [Indexed: 01/03/2023]
Affiliation(s)
- Steven G. Chopski
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA
| | - William B. Moskowitz
- Division of Pediatric Cardiology, Children's Hospital of Richmond and School of Medicine; Virginia Commonwealth University; Richmond VA
| | - Randy M. Stevens
- St. Christopher's Hospital for Children, Tenet Healthcare Corporation; Philadelphia PA USA
| | - Amy L. Throckmorton
- BioCirc Research Laboratory, School of Biomedical Engineering, Science and Health Systems; Drexel University; Philadelphia PA
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Baruteau AE, Barnetche T, Morin L, Jalal Z, Boscamp NS, Le Bret E, Thambo JB, Vincent JA, Fraisse A, Torres AJ. Percutaneous balloon atrial septostomy on top of venoarterial extracorporeal membrane oxygenation results in safe and effective left heart decompression. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 7:70-79. [PMID: 27742755 DOI: 10.1177/2048872616675485] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Transcatheter techniques are emerging for left atrial (LA) decompression under venoarterial extracorporeal membrane oxygenation (VA-ECMO). We aimed to assess whether balloon atrioseptostomy (BAS) is a safe and efficient strategy. METHODS All patients who underwent percutaneous static BAS under VA-ECMO at four tertiary institutions were retrospectively reviewed. RESULTS From 2000 to 2014, BAS was performed in 64 patients (32 adults and 32 children). Indications for ECMO support included acute myocarditis (31.3%) and non-myocarditis cardiac disease, mostly end-stage dilated cardiomyopathy (32.8%). BAS was required because of pulmonary oedema/haemorrhage and left ventricular (LV) distension. The mean balloon diameter was 21.8 ± 8.4mm. Adequate LA decompression was achieved in all patients. Mean LA pressure fell from 24.2 ± 6.9 mmHg to 7.8 ± 2.6 mmHg ( p < 0.001). The left-to-right atrial pressure gradient fell from 17.2 ± 7.1 mmHg to 0.09 ± 0.5 mmHg ( p < 0.001). Echocardiography showed an unrestrictive left-to-right atrial shunting in all patients. Improvement of day 1 chest X-ray was observed in 76.6% of patients, clinical status in 98.4% of patients and pulmonary haemorrhage in 14 out of 14 patients. Complications occurred in 9.4% of patients, representing pericardial effusion, fast atrial fibrillation, ventricular fibrillation requiring defibrillation, transient complete heart block and femoral venous dissection requiring covered stent placement. In the 37 (57.8%) patients who were successfully decannulated, the median ECMO duration was 9 (range: 4-24) days. After a median follow-up of 12.3 (range: 0.1-142) months, 35.9% patients died, 17.2% received a LV assist device as a bridge to transplantation, 31.2% were transplanted and 56.2% were home discharged and alive. CONCLUSIONS Percutaneous BAS may be a safe and efficient strategy for discharging the LA in both adults and children supported by VA-ECMO.
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Affiliation(s)
- Alban-Elouen Baruteau
- 1 Department of Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, UK.,2 Cardiology Clinical Academic Group, Cardiovascular and Cell Sciences Research Institute, St George's University of London, London, UK.,3 IHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France
| | - Thomas Barnetche
- 4 Department of Rheumatology, University Hospital Pellegrin, Bordeaux, France
| | - Luc Morin
- 5 Department of Pediatric Intensive Care, Paris South University Hospitals, Assistance Publique Hôpitaux de Paris, Le Kremlin-Bicêtre, France
| | - Zakaria Jalal
- 3 IHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France.,6 Department of Pediatric Cardiology, Haut-Lévèque Hospital, Bordeaux University, Bordeaux, France
| | - Nicholas S Boscamp
- 7 Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Emmanuel Le Bret
- 8 Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, Paris, France
| | - Jean-Benoit Thambo
- 3 IHU LIRYC, Electrophysiology and Heart Modeling Institute, INSERM U1045, Bordeaux, France.,6 Department of Pediatric Cardiology, Haut-Lévèque Hospital, Bordeaux University, Bordeaux, France
| | - Julie A Vincent
- 7 Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
| | - Alain Fraisse
- 1 Department of Paediatric Cardiology, Royal Brompton Hospital and Harefield NHS Foundation Trust, Imperial College London, London, UK
| | - Alejandro J Torres
- 7 Division of Pediatric Cardiology, Morgan Stanley Children's Hospital, New York Presbyterian Hospital, Columbia University Medical Center, New York, NY, USA
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