IMPELLA TUTORIAL 008: IMPELLA CP COMPONENTS PART 1
The Impella CP is a mechanical circulatory support device designed to provide percutaneous left ventricular assistance during percutaneous coronary interventions or cardiogenic shock.
Understanding the structure and functionality of the device's individual components is essential for optimizing its use, ensuring accurate placement, and minimizing potential complications.
A detailed overview of the various components of the Impella CP is provided, emphasizing their design, function, and contribution to achieving effective ventricular unloading and circulatory support.
In a structured manner, the components of the Impella CP can be divided into four categories: the Impella catheter, the purge system, the insertion kit, and the automatic impella controller.
ECMO HISTORY, A FASCINATING JOURNEY THROUGH THE EVOLUTION OF EXTRACORPOREAL LIFE SUPPORT. #ECMO
We can trace the origins of ECMO support to the early days of cardiopulmonary bypass. In 1953, John Gibbon successfully performed the first operation under cardiopulmonary bypass.
He repaired an atrial septal defect in an 18-year-old woman at the Jefferson Medical College of Philadelphia.
The patient underwent a successful intervention during 26 minutes of total cardiopulmonary bypass and survived hospital discharge without significant adverse events. This achievement was the result of two decades of prior research in circulatory support devices and artificial lungs.
It essentially consisted of a roller pump and a gas exchange area that involved small films of deoxygenated blood passing over a screen where it made direct contact with oxygen.
This system allowed circulatory support for a few hours to perform cardiac surgeries, but it was not useful for prolonged support in the ICU because direct exposure to oxygen caused damage to blood cells.In 1972, a 24-year-old man with severe acute respiratory distress syndrome caused by polytrauma became the first patient to successfully undergo prolonged extracorporeal life support for 75 hours at the Pacific Medical Center, ultimately recovering.
This event marked the advent of what we now call ECMO.
In the years that followed, attempts were made to validate its effectiveness in treating adult respiratory distress, but these efforts showed no significant impact on mortality.In contrast in 1972, doctors Bartlett and Gazzaniga successfully treated their first patient with ECMO after cardiac surgery, a 2-year-old infant who developed myocardial stunning following a Mustard procedure.
This represented the first use of cardiac ECMO, successfully providing 36 hours of support until recovery.
The team later documented a growing number of pediatric cardiac cases using this techniqueIn 1975, once again, doctors Bartlett and Gazzaniga achieved a new milestone.
That year, they successfully treated the first newborn using ECMO in a case of persistent ductus arteriosus with cyanosis.
They managed to sustain the baby’s circulation and oxygenation until the defect could be repaired, marking a pivotal moment in medical history.
This case proved to be crucial, because it initiated the study and development of extracorporeal support in newborns over the following 20 years.
Based on the neonatal experience, ECMO was subsequently reintroduced years later for adult respiratory and cardiac failure, paving the way for its widespread use across all age groups to treat both cardiac and respiratory failure, which is the current standard of care.