Unload the ventricle. Watch the inlet.
Sixteen Impella cases with a live AIC: P-levels, suction, malposition, afterload, purge, hemolysis, RV failure, HIT, and ECMELLA — numbers move continuously, not as quiz deltas.
Case library
16 scenarios
- CPintro6 min
Just implanted — still in shock
Anterior STEMI, Impella CP just placed femoral. Console: P-2, flow 1.5 L, MAP 54, lactate 5.2, CPO 0.42. Placement signal is aortic. Unload and restore perfusion.
Open console - CPintro6 min
Suction alarms after the diuresis
CP day 1. They diuresed 3 L overnight for wet lungs. Now SUCTION, flow 1.1 L at P-8, CVP 4, PCWP 6. Motor current has sagged.
Open console - CPintro6 min
Ready to step the P-level down?
Day 4 after a loaded anterior MI. Native output is returning, MAP 78 off pressors, lactate 1.3, CPO 0.92, P-8. Echo: AV opening, LV not dilating. Structured wean, not a yank.
Open console - CPintermediate7 min
Placement signal looks ventricular
Fresh CP. Placement signal is a ventricular blob, motor current flat-high (890 mA), flow 1.7 L at P-7. No echo since the table.
Open console - CPintermediate6 min
P-8 but only 1.8 litres
Hypertensive on leftover norepinephrine. SVR 2100, MAP 92, Impella CP at P-8, flow stuck at 1.8 L, lactate 3.4. Placement signal is fine.
Open console - CPintermediate7 min
Tea-colored urine
CP day 2. Urine is tea-colored, pfHb 62, LDH up. P-8, CVP 6, intermittent suction, motor current drifting. The fellow wants to spin higher for safety.
Open console - CPintermediate5 min
Purge pressure 1100
PURGE alarm. Pressure 1080 mmHg, purge flow dribbling. Patient MAP and placement signal are otherwise acceptable at P-6. Cassette looks dry at the luer.
Open console - CPintermediate6 min
Platelets crashing on day 5
CP day 5. Platelets 38k and falling, new mottling of the toes, HIT ELISA pending-then-positive. Purge is still heparinized D5W. Flow and position are acceptable.
Open console - CPintermediate5 min
Cannulated foot is cold
Femoral CP, MAP acceptable. The cannulated foot is cooler than the other, Doppler is weak, and no antegrade sheath was placed at implant.
Open console - CPintermediate6 min
Groin soaking through
Access site soaking the dressing, Hb 6.9 and falling, MAP 58. Position and P-level are fine. Purge is still heparinized. This is a groin, not a console problem.
Open console - CPintermediate6 min
VT storm, suction every burst
Recurrent VT. Each run empties the LV, SUCTION fires, MAP dives, then it recovers when sinus returns. P-7, otherwise well seated. They have already climbed P once during a run.
Open console - 5.5intermediate6 min
Axillary 5.5, still not filling
Surgically placed Impella 5.5 via the left axillary. P-7 should deliver close to 4.5 L; you have 2.1 L and SUCTION. CVP 5, small LV. Bigger motor, same inlet law.
Open console - RPintermediate6 min
RP in, CVP still 22
Inferior STEMI, isolated RV infarct. Impella RP at P-3, CVP 22, MAP 56, PAPi 0.7, liver edge down. The RV is still not being forwarded into the LV.
Open console - CPadvanced8 min
LV empty, RV huge
Anterior STEMI on CP at P-7. SUCTION, flow 1.3 L, CVP 19, PCWP 9, PAPi 0.55. Echo in the doorway: D-sign, huge RV, kissing LV walls.
Open console - CPadvanced7 min
CP at P-9, still dying
SCAI D. Impella CP at P-9, flow 3.3 L (the ceiling), MAP 50, lactate 8.1, CPO 0.46, still mottled. Position is perfect. This device is too small for this hole.
Open console - ECMELLAadvanced8 min
VA plus Impella, LV still loaded
VA-ECMO 4.5 L for refractory shock. Someone parked an Impella CP at P-2 “for unload.” PCWP 28, pulse pressure 4, smoke in the LV. VA is the afterload. The Impella is not doing its job.
Open console