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. Reduce P-level to P-2.

2. Press the MENU soft button and select Repositioning Guide using the selector knob.

3. Press the START soft button to initiate the repositioning guide.

4. Press and hold the anchor button to unlock the Impella catheter prior to repositioning. Press the DONE soft button to continue.

5. Pull the Impella Catheter slowly–1cm at a time–while monitoring for an aortic placement signal waveform on the Automated Impella Controller screen. When the placement signal shifts to aortic, stop pulling the Impella Catheter. Press the DONE soft button to continue.

6. Using the centimeter markings on the catheter, pull the Impella back slowly and additional 3 centimeters. Press the DONE soft button to continue.

7. Release the anchor button to lock the Impella catheter in place. Press the DONE soft button to continue.

8. Press the DONE soft button to exit the repositioning guide. Ramp up slowly to the preferred P-level after exiting the guide.

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