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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
Intracerebral Hematoma in Patients With Impella Ventricular Assist Device Placement for Cardiogenic Shock: Report of
Mitsuki Horio1, Daina Kashiwazaki1, Takahiro Tomita1
1Department of Neurosurgery, Toyama University Hospital, Toyama, JPN.
Insights
Intracerebral hemorrhage is a serious complication of Impella implantation for cardiogenic shock. Hematoma evacuation can be effective, but bleeding risk remains a concern.
Area of Science:
- Cardiology
- Neurology
- Medical Devices
Background:
- The Impella device is crucial for managing cardiogenic shock.
- Bleeding complications, including intracerebral hemorrhage, can occur with Impella use.
Observation:
- Three cases of intracerebral hemorrhage in patients with Impella implantation for cardiogenic shock are presented.
- Patients underwent hematoma evacuation for treatment.
- Clinical features, diagnosis, and management strategies were detailed for each case.
Findings:
- Intracerebral hemorrhage developed in patients post-Impella implantation.
- Hematoma evacuation was performed in all cases, with varying intraoperative blood loss.
- One patient died 14 days after admission.
Implications:
- Intracerebral hemorrhage is a significant cause of morbidity in patients receiving Impella.
- While hematoma evacuation is the optimal treatment, managing associated bleeding is challenging.
Abstract:
Despite the clear benefits of Impella in patients with cardiogenic shock, bleeding is a possible complication. Herein, we report three cases of intracerebral hemorrhage in patients with Impella implantation for cardiogenic shock, which were treated with hematoma evacuation. We present the clinical features, diagnosis, and management (hematoma evacuation) of patients with the Impella device (Abiomed, Danvers, Massachusetts) who developed intracerebral hemorrhage. Case one was a 56-year-old man who presented with chest pain and loss of consciousness, was diagnosed with acute myocardial infarction, and underwent urgent percutaneous coronary intervention and Impella placement. After eight days, the patient developed anisocoria. Computed tomography revealed a left intracerebral hemorrhage. An emergency hematoma evacuation was successfully performed (intraoperative blood loss: 2600 mL). Case two was a 54-year-old male who presented with persistent chest pain and loss of consciousness, was diagnosed with acute myocardial infarction, and underwent an emergency percutaneous coronary intervention with Impella implantation and venoarterial extracorporeal membrane oxygenation. The patient developed intracerebral hemorrhage after 26 days. Hematoma evacuation was successfully performed (intraoperative blood loss: 380 mL). Case three was a 52-year-old male who presented with dyspnea and hypotension, was diagnosed with dilated cardiomyopathy, and underwent Impella implantation and venoarterial extracorporeal membrane oxygenation, followed by which the patient developed subcortical hematoma. An emergency hematoma evacuation was performed (intraoperative blood loss: 3205 mL). The patient died 14 days after admission. Intracerebral hemorrhage is a potential cause of morbidity associated with Impella placement. Although hematoma evacuation is optimal, the bleeding tends to increase.
