Impella Cardiac Power Device used in Patient with Cardiogenic Shock Due to Non-Ischemic Cardiomyopathy

The percutaneous Impella CP (Cardiac Power; Abiomed, Inc., Danvers, MA) was designed to provide a higher level of cardiac support than Impella 2.5 (Abiomed, Inc.). We present a case of a patient in which we used Impella CP in the setting of refractory cardiogenic shock due to non-ischemic cardiomyopathy. A 33-year-old male patient known to have idiopathic dilated non ischemic cardiomyopathy, presented to King Abdulaziz university Hospital with progressive dyspnea, orthopnea and lower limbs edema, BP was 97/50 with heart rate of 97 bpm, he was admitted initially to medical floor and Lasix infusion. His echocardiogram showed biventricular failure with left ventricular EF of 10%. Over the course of the subsequent three days, the patient's condition deteriorated and became hemodynamically unstable, where he was shifted to ICU and started on inotropes. In the ICU, he became critically ill with severe multiorgan failure. His conscious level started to deteriorate; thus, he was Intubated and mechanically ventilated. His hemodynamic profile shows severe cardiogenic shock, despite the fact that he was on maximum dose of levophid, dopamine and epinephrine, he was taken to cardiac catheterization laboratory, right heart catheterization using swan catheter shows right atrial pressure 28 mmHg, pulmonary capillary wedge pressure 30 mmHg, with cardiac index 1.6 L/min. Impella CP was inserted which can provide up to 3.5 L/min of cardiac output. Over the course of the next 72 hours, the patient showed significant improvement in his hemodynamics profile and cardiac function (LVEF 28% estimated by echocardiogram), with recovery of liver function. The Impella CP was removed with no complications. The Impella CP was shown to be safe and effective for prolonged use in critically ill patients with non-ischemic cardiomyopathy, and may significantly improve their outcome & prognosis.