Hemostasis Matters in a Patient With an Impella 5.0 for Refractory Cardiogenic Shock

An 80-year-old man with a broad anterior ST-segment elevation myocardial infarction complicated by cardiogenic shock (CS) experienced near pulselessness after non-sustained ventricular tachycardia. After introducing venoarterial extracorporeal membrane oxygenation (VA-ECMO) and an Impella CP (Abiomed Japan, Tokyo, Japan), successful reperfusion with a drug-eluting stent was performed. Given the refractory CS, instead of the VA-ECMO and Impella CP, an Impella 5.0 was implanted through the right axially artery via a vascular graft 3 days after the admission. In addition to dual antiplatelet therapy, unfractionated heparin was administered to ensure the activated partial thromboplastin time was 1.5- to 2-fold the normal value. Continued anemia due to a right subclavian hematoma even under a conventional pressure dressing with adhesive tape required blood transfusions (Figure A). Hemostasis was successfully achieved by 7 days of compression with a Heart Band (CERVIN, Kyoto, Japan; Figure B), which was invented to prevent hematomas and skin erosions after the implantation of cardiovascular implantable electronic devices.¹ The Heart Band was especially beneficial when the patient was sitting and standing during rehabilitation.

Figure.

(A) An intractable hematoma at the insertion site of an Impella 5.0 (white arrow) before compression with a Heart Band, and a skin erosion (black arrow) with a conventional pressure dressing with adhesive tape. (B) Successful achievement of hemostasis with the Heart Band. The dashed line and black arrow indicate the shaft of the Impella 5.0 under and outside the Heart Band, respectively.

The Impella 5.0 provides powerful support for patients with refractory CS and is advantageous for long-term implantations and rehabilitation. However, intractable insertion site hematomas may occur, for which the Heart Band may be effective.

Acknowledgments

The authors thank Mr. John Martin for help with English language editing.

Disclosures

Y.N. has received lecture fees from Abiomed. The remaining authors have no conflicts of interest to disclose.

Reference

• 1.   Kiuchi K, Okajima K, Tanaka N, Yamamoto Y, Sakai N, Kanda G, et al. Novel compression tool to prevent hematomas and skin erosions after device implantation. Circ J 2015; 79: 1727–1732.