3 steps to assess a patient’s readiness to wean or remove Impella® support

Weaning or removing temporary mechanical circulatory support doesn’t have to be daunting. These three steps will help you make the best decision for your patient:

1. Assess readiness to wean: Make sure the patient's hemodynamic status has improved, the doses of vasoactive medications required are declining, and the end-organ function is stable (e.g., kidneys, liver, and brain). Also, consider the indication for the original placement of the Impella® device as this will impact the timeline for weaning.

2. Weaning trial: tailor the weaning trial to the patient's specific needs. Maintain a cardiac index above 2.2 L / min / M² despite decreasing mechanical support to keep the patient out of cardiogenic shock. Fast weaning protocols reduce the power level every two hours, while slower protocols reduce it every 12 hours.

   Watch the full video lesson for more specifics on weaning, an explanation of cardiac power output, and more.

3. Removal of Impella®: the removal process requires an experienced clinician to ensure hemostasis, assess for arterial injury, and use a percutaneous closure device. 

Possible complications of an Impella® device include oozing, hematoma, pseudoaneurysm, or retroperitoneal bleeding.

Your patient returns from the cath lab with an intra-aortic balloon pump. Now what? 

Whether you are looking after patients with an IABP, Impella®, ECMO, or TandemHeart®, you'll learn about the types of acute mechanical circulatory support, their indications and contraindications, and the basics of managing these devices.