From the Guidelines
For a patient on Impella CP support, maintaining a mean arterial pressure (MAP) that provides adequate cerebral and end-organ perfusion while minimizing LV afterload is crucial, with a typical range of 60-90 mmHg considered acceptable. The systolic blood pressure should generally be maintained above 90 mmHg, while diastolic pressure should be above 50 mmHg 1. These parameters may need adjustment based on the patient's specific clinical condition and baseline blood pressure. When managing these patients, it's essential to recognize that the arterial line pressure represents the patient's native cardiac output plus the Impella contribution.
Key Considerations
- If blood pressure falls below these targets, consider increasing the Impella performance level (P-level), administering vasopressors like norepinephrine (starting at 0.05-0.1 mcg/kg/min) or vasopressin (0.04 units/min), or providing volume resuscitation if the patient is hypovolemic 1.
- Conversely, if blood pressure is excessively high, the Impella support can be reduced or antihypertensive medications administered.
- Blood pressure goals should be individualized based on end-organ perfusion, with attention to urine output, mental status, lactate levels, and other markers of adequate tissue perfusion.
Management Strategies
- The use of vasoactive drugs, such as norepinephrine, can help optimize blood pressure and cardiac output 1.
- Invasive monitoring may be necessary to measure hemodynamic parameters accurately and to determine the most appropriate combination of medications to optimize perfusion 1.
- The Impella device itself requires adequate pressure gradients to function optimally, so maintaining these blood pressure targets helps ensure both patient stability and proper device performance.
From the Research
Acceptable Measured Blood Pressure at the Arterial Line for a Patient on Impella CP Support
- The ideal measured blood pressure at the arterial line for a patient on Impella CP support is not explicitly stated in the provided studies.
- However, study 2 suggests that maintaining a mean arterial pressure (MAP) of equal to or greater than 65 mmHg may be a reasonable target in postcardiac arrest patients admitted to the ICU with vasopressor support.
- Study 3 mentions that Impella increases mean arterial pressure (MAP) and systemic blood flow, thereby improving peripheral organ perfusion and promoting recovery from multiple organ failure.
- Study 4 evaluates the use of vasopressors and inotropes as predictors of mortality in patients treated with the Impella for acute cardiogenic shock, but does not provide specific guidelines for acceptable measured blood pressure at the arterial line.
- Studies 5 and 6 provide an overview of Impella and mechanical devices in cardiogenic shock, as well as a review of the Impella devices, but do not provide specific information on acceptable measured blood pressure at the arterial line for a patient on Impella CP support.
Key Findings
- Maintaining a MAP of equal to or greater than 65 mmHg may be a reasonable target in postcardiac arrest patients admitted to the ICU with vasopressor support 2.
- Impella increases MAP and systemic blood flow, improving peripheral organ perfusion and promoting recovery from multiple organ failure 3.
- The use of vasopressors and inotropes is associated with increased mortality in patients treated with the Impella for acute cardiogenic shock 4.