Joseph Parrillo, MD, Brian Porvin, DO, and Steven Keller, MD, Ph.D., discuss managing patients in the CCU with Impella®. The physicians discuss the growing use of Impella as a strategy for both unloading and transition when it comes to ECMO. They describe the importance of LV unloading strategies, such as early insertion of an Impella device, to offload the left ventricle. Dr. Keller explains the risks of not placing Impella early and emphasizes the strong physiologic argument supporting the unloading of the LV to decrease myocardial oxygen consumption, decrease myocardial work, and promote cardiac recovery. The physicians also discuss the shortcomings of using pulse pressure and other invasive hemodynamics to evaluate pulsatility and forward flow. They conclude their discussion by describing how each of their institutions decides when to choose Impella and when to choose ECMO and what the progression from one to the other may look like.
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