Professor of Clinical Medicine Penn Medicine Penn Medicine Philadelphia, Pennsylvania, United States
Background: Impella 5.5 is a full support microaxial flow pump (I5.5-mAFP) utilized to stabilize patients with HF refractory to medical therapy. These patients have been committed to an ICU and waiting for long periods for OHT. We report experience with a successful pilot caring for these patients on a step down.
Methods: A pilot program was initiated to determine criteria to define stable patients on I5.5-mAFP who were listed for transplant and felt to stable for care on the floor at a high volume academic institution. Patients must be identified during the day and assessed by the receiving cardiologist, appropriate for a 2:1 nurse ratio, stable for 5 days post implantation, minimal changes in inotrope (milrinone/dobutamine) dose for 24 hours, ambulatory, stable vital signs, independent in their ADLs, neurologically intact, stable O2 requirement, VAD position, site, P-level, and no active bleeding. Intense education was performed with the Advanced Practice Providers (APPs) who would be primarily caring for these patients.
Outcome: The pilot program went live July 1, 2024 and due to success, became standard of care December 2024. 6 unique patients saved 45 ICU days. There were no deaths and all paitents were successfully transplanted. 2 patients did have to return to the unit, one for increased hemodynamic monitoring and one for cardiac tamponade (who eventually was able to return to the step down floor after he recovered from pericardial window).
Conclusion: With intense APP education and clearcut guidelines, it is safe and feasible to care for patients who are hemodynamically stable on I5.5-mAFP on a stepdown unit. The available ICU beds can then be allocated to critically ill or post operative patients.
