Insertion of impella cp cardiac support device was planned for protection during procedure.After obtaining access, the impella sheath was inserted, an impella cp device advanced then turned on.Position check multiple times, however, could not get decent flow (flow below 1l/min).Multiple suction arms were signaling on the device.Position appeared good, continued efforts at prepositioning the device did not change hemodynamics.The impella device was removed, placed on back table and tested in a saline solution.The device woke on level 4 with flows at 2.5 l per minute.The pigtail was readvanced ensuing it was not under papillary muscles and the impella device exchanged over the impella wire.Again a decent flow could not be obtained with a flow remaining under 1l per minute.Note the pressure was 17 to 20 mmhg on second time device loaded signifying the pt had preloaded support.The pt began to deteriorate hemodynamically fairly quickly, bp in 40s, and pt not responding to multiple vasopressors.Ejection fracture and wedge pressures verified, impella device remained in left ventricle.Stat echo-cardiogram revealed lv function deterioration with multiple wall motion abnormalities.Pt non responsive to efforts, cpr initiated.Salvage attempt to dilate ramus cx and lad, pt arrested again.Heart essentially lost all pulsatility.Team unable to resuscitated pt, who expired.
|