Mercy Regional Medical Center started using the Impella heart pump, the world’s smallest heart pump, on patients experiencing cardiogenic shock, or heart failure, in July.
Within the first week, the pump was used on a heart attack patient. It kept blood circulating successfully throughout the patient’s body until he could receive higher levels of care at Penrose Hospital in Colorado Springs.
The doctor who inserted the Impella heart pump said the patient would have died had it not been for the device.
After a heart attack, the heart can go into shock, and it is unable to pump blood to other organs. As blood pressure drops, the body can go into shock. The Impella heart pump, about 4.2 millimeters long, temporarily pumps blood from the heart to the rest of the body to keep patients alive during procedures such as heart stent surgery.
Dr. Andrew Carter and Dr. Susie Kim, cardiologists at Mercy, brought the technology to Durango because of the medical center’s remoteness. Carter joined the cardiology team at Mercy in May to implement Impella technology into Mercy’s practices.
Mercy is one of the only places that offers advanced cardiology services in the Four Corners. About 10% of heart attack patients who go to Mercy for care will experience shock, Carter said. Of that 10%, mortality rates from the shock were as high as 30%. With the Impella heart pump, the mortality rate drops below 25%.
Now, if 10 people enter the cardiology department extremely sick, Impella is expected to save two or three of those lives.
“This is a new opportunity to improve outcomes for patients,” Carter said.
How it worksThe Impella heart pump keeps blood flowing continually from a ventricle in the heart to the rest of the body, even when the heart stops pumping. It allows more time for doctors to identify what caused the heart attack and provide the patient with a permanent solution.
Originally designed by researchers in Europe, the technology behind Impella has been around for a decade. But over the past three or four years, the technology has improved so much it is considered an “essential part of a practice supporting a large geographic region,” Carter said.
Depending on a patient’s condition and situation, the Impella heart pump remains in the body anywhere from 24 to 72 hours. It is implanted before the heart stops as a supportive and preventive measure before a larger procedure, such as angioplasty, a procedure used to open clogged heart arteries.
Patients can travel to the Front Range for open heart surgery with Impella temporarily implanted in their heart, without fear of going into shock before the procedure can occur.
Other procedures performed at Mercy, such as heart stents, can be dangerous, as they stop blood from flowing in the heart, said Linden Lane, a nurse at Mercy.
“Impella can really save these guys’ lives,” Lane said.
The Impella heart pump is inserted through the skin into the femoral artery, and guided by doctors with a catheter into a blood vessel in the heart. Patients are moderately sedated but awake enough to answer questions, Lane said. The only thing they feel is pressure at the site of injection.
The heart pump remains in the heart until the procedure is finished, and then it is removed.
Benefits for the regionIf patients are so sick they can’t fly, or a winter storm is preventing travel, Impella allows cardiologists at Mercy to provide “as much care as a patient would receive anywhere else,” Carter said.
Impella has allowed Mercy to keep and treat five patients instead of sending them to the Front Range.
“If they need a heart transplant, we can keep them here until they can go travel somewhere else for that,” Carter said.
The amount of blood Impella can pump has increased over time. The heart needs to pump 4 to 6 liters of blood per minute to keep the body functioning. Impella could only pump 2 or 2.5 liters when the technology was first released, but it has since advanced to 3.5 or 4 liters.
That means Impella can retain sufficient blood flow for a patient even if the heart is standing still.
“It’s eerie,” Carter said.
Kim recalled a patient with two diseased arteries. During the patient’s procedure, blood pressure dropped and the heart flatlined, meaning it was no longer pumping blood.
Before Impella, doctors would halt the procedure and perform CPR. But the small heart pump took over moving blood throughout the body, and doctors were able to finish the procedure without being rushed and without the patient’s body shutting down.
Without this device, the patient would most likely die in this situation, Carter said.
Doctors have used the device at Mercy just short of 10 times since July. Inserting the Impella heart pump alone can take anywhere from two to four hours, but in most cases the device is removed at the end of a permanent-fix procedure, Kim said.
“There is other technology we will consider bringing into the facility down the road,” Carter said. “It’s an area we feel we want to spend a focused effort.”