2024 Q2 Critical Care Transport Update Webinar

In this Q2 critical care transport update webinar, Jena Billig, BSN, RN, CCRN, CFRCN, Abiomed’s West Coast critical care transport trainer, discusses right ventricular (RV) failure and right-sided Impella devices.

After a video vignette featuring a patient successfully supported with Impella RP®, Jena provides an overview of the pathophysiology of RV dysfunction and failure. She explains that RV dysfunction is an abnormality in the structure or function of the RV while right ventricular failure is a clinical syndrome with signs and symptoms of heart failure resulting from RV dysfunction. Among patients with acute myocardial infarction (AMI) cardiogenic shock, 37% will experience RV failure, which is associated with worse outcomes, longer ICU stays, higher short-term mortality, and worsening end-organ dysfunction.

Jenna discusses the determinants of RV function: preload, PA load or RV afterload, pericardial compliance, and contractility of the septum and RV-free wall. She talks about the etiology of right ventricular dysfunction, emphasizing that the #1 cause of RV dysfunction is left ventricular failure.

Jena describes the pathophysiology of RV dysfunction and the diagnosis of RV failure, describing hemodynamics, echocardiographic findings, clinical manifestations/presentation, and LVAD-specific signs in these patients. She reviews medical management of RV failure—volume management, inotropic therapy, pulmonary vasodilators—as well as invasive management strategies, including temporary and durable left and right ventricular assist devices (LVADs and RVADs), extracorporeal membrane oxygenation (ECMO), and heart transplantation.

Jena reviews the key benefits of Impella RP and Impella RP Flex support and discusses insertion and physiologic effects. In her discussion of patient management, she addresses proper Impella placement, assessment of insertion sites, handling suction alarms, device securement and positioning for success in transport, as well as other best practices.

The session concludes with a big-picture best practices review—highlighting the PAP mnemonic (preload, afterload, position and purge), CPR/defibrillation considerations, suction, and malposition—and a brief Q&A.