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.
Introductory session
A seated pump. Just the AIC.
No briefing, no guided questions, no free-play goals. Turn P-level on a filling ventricle — CP, 5.5, or RP. Watch placement, flow, MAP, and CPO — a small screen names what changed.
Case library
16 scenarios
- CPintro6 min
Case 01 — After implant
Anterior STEMI, Impella CP just placed femoral. Left at P-2. Flow 1.5 L, MAP 54, lactate 5.2, CPO 0.42. Placement signal looks aortic.
Open console - CPintro6 min
Case 02 — After 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
Case 11 — Weaning assessment
Day 4 after a loaded anterior MI. Native output returning, MAP 78 off pressors, lactate 1.3, CPO 0.92, still at P-8. Echo: AV opening, LV not dilating.
Open console - CPintermediate7 min
Case 03 — Console waveforms
Fresh CP. No echo since the table. Placement signal looks ventricular, motor current flat-high (890 mA), flow 1.7 L at P-7.
Open console - CPintermediate6 min
Case 04 — Flow lower than expected
Hypertensive on leftover norepinephrine. SVR 2100, MAP 92, Impella CP at P-8, flow stuck at 1.8 L, lactate 3.4. Placement signal looks aortic.
Open console - CPintermediate7 min
Case 05 — Dark 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
Case 06 — Purge alarm
PURGE alarm. Pressure 1080 mmHg, purge flow dribbling. MAP and placement signal are otherwise acceptable at P-6. Cassette luer looks dry.
Open console - CPintermediate6 min
Case 08 — Day 5 thrombocytopenia
CP day 5. Platelets 38k and falling, new mottling of the toes, HIT ELISA just positive. Purge is still heparinized D5W. Flow and position are acceptable.
Open console - CPintermediate5 min
Case 09 — Cool foot
Femoral CP, MAP acceptable. Cannulated foot cooler than the other, Doppler weak. No antegrade sheath was placed at implant.
Open console - CPintermediate6 min
Case 10 — Groin bleeding
Access site soaking the dressing, Hb 6.9 and falling, MAP 58. Position and P-level are fine. Purge heparin is still running.
Open console - CPintermediate6 min
Case 12 — Recurrent VT
Recurrent VT. Each run the console throws SUCTION and MAP dives, then recovers in sinus. P-7, otherwise well seated. They already climbed P during a run.
Open console - 5.5intermediate6 min
Case 14 — 5.5, still hypotensive
Surgically placed Impella 5.5 via the left axillary. P-7, flow 2.1 L and SUCTION. CVP 5. Last echo showed a small LV.
Open console - RPintermediate6 min
Case 15 — After RP implant
Inferior STEMI. Impella RP at P-3, CVP 22, MAP 56, PAPi 0.7, liver edge down, urine off.
Open console - CPadvanced8 min
Case 07 — Worsening right heart
Anterior STEMI on CP at P-7. SUCTION, flow 1.3 L, CVP 19, PCWP 9, PAPi 0.55. Echo from the doorway: D-sign, large RV, small LV.
Open console - CPadvanced7 min
Case 13 — Still in shock
SCAI D. Impella CP at P-9, flow 3.3 L, MAP 50, lactate 8.1, CPO 0.46, still mottled. Position looks correct.
Open console - ECMELLAadvanced8 min
Case 16 — Combined support
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, aortic valve barely opening.
Open console