Using the Repositioning Guide with SmartAssist®

This Impella® skills video demonstrates how to reposition either the Impella CP® with SmartAssist® or the Impella 5.5® with SmartAssist® using the Repositioning Guide. The Repositioning Guide allows you to reposition the Impella without echocardiography. It is only available when a red “Impella Position in Ventricle” alarm occurs.

The Automated Impella Controller™ (AIC) displays a red “Impella Position in Ventricle” alarm when it detects that the optical sensor on the Impella CP with SmartAssist or Impella 5.5 with SmartAssist is below the aortic valve, indicating that the Impella is too far into the left ventricle and both the inlet and outlet areas are below the aortic valve. The AIC displays a ventricular waveform for both the aortic and LV placement signals and a flat motor current waveform. When this occurs the Impella is not hemodynamically supporting the patient and needs to be repositioned.

To reposition the Impella, follow the steps displayed with the red “Impella Position in Ventricle” alarm.

1. Press the FLOW CONTROL soft button and turn the selector knob to reduce the P-level to P-2. Press the selector knob to confirm P-2.
2. Press the MENU soft button and turn the selector knob to select “Repositioning Guide.” Press the selector knob to confirm your selection.
3. Press the soft button adjacent to the START prompt and follow the Repositioning Guide prompts on the screen. Press DONE after each step to advance to the next step.
4. Turn the Tuohy-Borst valve counterclockwise to loosen it and unlock the Impella catheter. 
5. Pull the Impella back slowly 1 cm at a time until the placement signal on the AIC shifts from a ventricular waveform to an aortic waveform and stop.
6. Using the centimeter markings on the catheter, slowly pull the Impella back an additional 3 centimeters.
7. Turn the Tuohy-Borst valve clockwise to tighten it and lock the Impella catheter.
8. The last instruction is to slowly increase the performance level. Press DONE and then press FLOW CONTROL and use the selector knob to scroll to and select the desired P-level.

Echocardiography can be used to confirm proper positioning of the Impella CP with SmartAssist or Impella 5.5. with SmartAssist.