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In this 320th episdode I welcome Drs. Essandoh and Cody back to the show to discuss the latest data and guidelines around the use of the Impella device and how it compares to IABP and ECMO.
CME: Link
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With the PA device, assuming the PAC comes out. How are pulmonary pressures measured if at all?
From the guests:
For the Impella 5.5, leaving a PAC in place to guide hemodynamic measurement is considered best practice. However, clinically, many centers remove PACs when patients needing longer-term Impella support (such as those being bridged to transplant) are extubated and stable. So, it is quite variable, and the assumption is that as the left heart recovers, PAPs and RV function should follow suit, assuming they were within normal limits during Impella implantation.
If by “PA device” you meant the Impella RP Flex with SmartAssist then the device provides PA pressures and calculates a PAPi on the SmartAssist screen. However, the manufacturer strongly encourages the use of PA catheters to guide patient management, as the inlet and outlet of the RP Flex may abut a cardiac structure, rendering measured pressures erroneous.