Impella® Transport Considerations

Adam Gottula, M.D., a critical care fellow at the University of Michigan, Ann Arbor, highlights key information for physicians involved in transporting critically ill patients with mechanical circulatory support (MCS) devices such as Impella. Dr. Gottula recently published a paper in Air Medical Journal titled “Impella in Transport: Physiology, Mechanics, Complications, and Transport Considerations.”

Optimizing patient care before transport

Dr. Gottula describes the importance of selecting a transport service for patients supported with Impella, “I think it is really important to realize that not every helicopter or critical care transport organization is created equal,” he explains. When considering available transport services, Dr. Gottula emphasizes the need to select a transport service familiar with the MCS device supporting the patient, “because that’s not something that they’re going to be able to truly manage on the fly.”

He explains that prior to the transport service arriving, it is important to secure the Impella and to consider using a knee immobilizer on the patient to help prevent Impella movement during transport. He also explains that he finds it helpful to mark the Impella device where it enters the skin to provide “a very tangible measure” of whether Impella is moving during transport.

He also states that a pulmonary artery (PA) catheter is helpful if the transport service has the ability to monitor it throughout flight.

Optimizing patient care during transport

Dr. Gottula explains that during transport the most important consideration is device position. To help keep Impella correctly positioned, it is important to minimize moving the patient during transport and mark the correct position ahead of time to detect device migration. He describes the importance of being familiar with the different waveforms on the Impella controller to help assess position. Dr. Gottula also states that transport services with ultrasound capability onboard the aircraft can use ultrasound to assess Impella position.

Optimizing patient care from the receiving end

From the perspective of the hospitals receiving patients, Dr. Gottula explains that it is important for centers to educate their own transport teams, “I think the best things we can do for our patients is to reach out to these institution-affiliated transport teams and help them train and help educate them on the devices ahead of time so that when they encounter clinical challenges, they’re doing what the receiving facility would want them to do.”

Future directions

Dr. Gottula explains that there are currently no standardized protocols for transporting patients supported with MCS, “I think the first thing we have to do is take a step back and review transports on a larger scale to see what are our common complications, and we’re actually in the midst of doing that right now. . .We want to approach this problem with a unified front and be able to develop best practices that we can take on a national level, as certainly Impella use is only going to increase in the years to come.”