Key result
Staged removal of the femoral access during escalation from IABP to Impella 5.5 achieved successful hemostasis in 66.7% (4 of 6) of patients, with the remaining 2 requiring escalation to EC-PELLA.
Why the study?
With the growing population of advanced heart failure, the use of Impella 5.5 has been increasing, prompting the need for an effective strategy to remove an IABP when escalating support.
Does a staged removal strategy of IABP over a long wire with short sheath insertion provide secure hemostasis and allow transition to further support during escalation to Impella 5.5 in advanced heart failure patients?
Case Report (n=6)
Does a staged removal strategy of IABP over a long wire with short sheath insertion provide secure hemostasis and allow transition to further support during escalation to Impella 5.5 in advanced heart failure patients?
A staged IABP removal strategy using a long wire and short sheath during Impella 5.5 escalation achieves secure hemostasis and facilitates transition to ECMO if needed.
Wire-guided IABP removal during Impella 5.5 escalation may be feasible; leaves open safety and efficacy in larger cohorts.
Background: With the growing population of advanced heart failure, the use of Impella 5.5 has been increasing. Here, we report an effective strategy of removing the intra-aortic balloon pump (IABP) in the setting of escalation of support to Impella 5.5. Results: From January 1, 2022 to June 30, 2022, a total of 6 patients have undergone IABP removal during Impella 5.5 insertion. The IABP was subsequently removed over the long wire with manual compression on the femoral artery to control bleeding. An 8 or 9 Fr short sheath is inserted over the wire. Staged hemostasis was successfully performed in 4 patients, and the remaining two patients required escalation of support to veno-arterial membrane oxygenation as EC-PELLA utilizing the femoral arterial sheath. Conclusion: This does not only achieve secured hemostasis but also enables a smooth transition to further escalate support such as extracorporeal membrane oxygenation support, if necessary.
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Sosa et al. (2022) conducted a case report in Advanced heart failure (n=6). Staged removal of femoral access (IABP removal over a long wire with short sheath insertion) was evaluated on Successful staged hemostasis. Staged removal of the femoral access during escalation from IABP to Impella 5.5 achieved successful hemostasis in 66.7% (4 of 6) of patients, with the remaining 2 requiring escalation to EC-PELLA.
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