Automated Impella® Controller (AIC): Understanding and Navigating the Placement Screen

Do you understand all the elements displayed on the Automated Impella® Controller (AIC) placement screen? In this video, Advanced Impella Trainer Jo Kajewski walks through the soft buttons, waveforms, and other information displayed on the placement screen to help you understand this information and navigate through the displays when you have a patient on Impella® support.

Along the right side of the display, there are five soft buttons you can press:

Press MUTE ALARM to silence any alarms that occur. These may be red alarms indicating that Impella is not functioning to support the patient, yellow alarms indicating the that pump is functioning but not adequately supporting the patient, or white informational alarms.

Press FLOW CONTROL to adjust the amount of flow (P-level) for the patient. When you adjust the P-level, the Impella flow information in the lower left corner changes.

Press DISPLAY to change what you are looking at on the screen. While you will display the placement screen most of the time, you can use this button to change to other displays such as the infusion history screen or a screen that can show the patient’s family where the Impella sits in the heart.

Press PURGE SYSTEM to take action on the purge system, the integrated IV pump with G5 with 25 U/mL of heparin that protects the Impella motor. For example, you would press this button when you need to change the purge solution or purge cassette.

Press MENU to look at other types of information, such as alarm history.

Several types of information are displayed along the bottom of the placement screen:

Impella Flow displays the additional amount of flow the patient is receiving. The large number displays the average amount of flow at the current P-level. Because the native heart is also providing flow, the fraction to the left of this number displays the max flow over the min flow during the cardiac cycle.

Purge System displays the rate that the purge solution is flowing (Purge Flow) and the amount of pressure behind the purge flow (Purge Pressure).

Cardiac Output displays the patient’s cardiac output (CO).

Cardiac Power Output is automatically calculated by the AIC to allow for trending of CPO.

The placement screen has two waveform windows:

Placement Signals. The red waveform window displays two waveforms: a red AO (aortic) placement signal, and a white LV (ventricular) placement signal.

• AO waveform is from the optical sensor located where the cannula and outflow meet.
• LV waveform is an estimated waveform derived from the optical sensor and the motor current.

Motor Current. The green waveform window displays the motor current, which reflects the amount of energy and flow through the cannula. This waveform helps you understand Impella positioning.

When the Impella is properly placed, the motor current will be pulsatile, with peaks when the aortic valve is open and there is more energy and flow, and valleys when the aortic valve is closed and there is less energy and flow.

When the Impella drifts out of position, the motor current will be flat because the aortic valve is no longer creating the pressure gradient across the cannula.