Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach

Charlotte J. Van Edom; Mario Gramegna; Luca Baldetti; Alessandro Beneduce; Thomas Castelein; Dieter Dauwe; Pascal Frederiks; Gennaro Giustino; Marc Jacquemin; Stefan P. Janssens; Vasileios F. Panoulas; Janine Pöss; Alexander Rosenberg; Hannah A.I. Schaubroeck; Benedikt Schrage; Guido Tavazzi; Thomas Vanassche; Leen Vercaemst; Dirk Vlasselaers; Pascal Vranckx; Jan Belohlavek; Diana A. Gorog; Kurt Huber; Alexandre Mebazaa; Bart Meyns; Federico Pappalardo; Anna M. Scandroglio; Gregg W. Stone; Dirk Westermann; Alaide Chieffo; Susanna Price; Christophe Vandenbriele

doi:10.1016/j.jcin.2023.05.043

Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach

Charlotte J. Van Edom, Mario Gramegna, Luca Baldetti, Alessandro Beneduce, Thomas Castelein, Dieter Dauwe, Pascal Frederiks, Gennaro Giustino, Marc Jacquemin, Stefan P. Janssens, Vasileios F. Panoulas, Janine Pöss, Alexander Rosenberg, Hannah A.I. Schaubroeck, Benedikt Schrage, Guido Tavazzi, Thomas Vanassche, Leen Vercaemst, Dirk Vlasselaers, Pascal VranckxJan Belohlavek, Diana A. Gorog, Kurt Huber, Alexandre Mebazaa, Bart Meyns, Federico Pappalardo, Anna M. Scandroglio, Gregg W. Stone, Dirk Westermann, Alaide Chieffo, Susanna Price, Christophe Vandenbriele

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Abstract

Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.

Original language	English
Pages (from-to)	1707-1720
Number of pages	14
Journal	JACC: Cardiovascular Interventions
Volume	16
Issue number	14
Early online date	24 Jul 2023
DOIs	https://doi.org/10.1016/j.jcin.2023.05.043
Publication status	Published - 24 Jul 2023

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© 2023 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/
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Van Edom, C. J., Gramegna, M., Baldetti, L., Beneduce, A., Castelein, T., Dauwe, D., Frederiks, P., Giustino, G., Jacquemin, M., Janssens, S. P., Panoulas, V. F., Pöss, J., Rosenberg, A., Schaubroeck, H. A. I., Schrage, B., Tavazzi, G., Vanassche, T., Vercaemst, L., Vlasselaers, D., ... Vandenbriele, C. (2023). Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach. JACC: Cardiovascular Interventions, 16(14), 1707-1720. https://doi.org/10.1016/j.jcin.2023.05.043

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title = "Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach",

abstract = "Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.",

author = "{Van Edom}, {Charlotte J.} and Mario Gramegna and Luca Baldetti and Alessandro Beneduce and Thomas Castelein and Dieter Dauwe and Pascal Frederiks and Gennaro Giustino and Marc Jacquemin and Janssens, {Stefan P.} and Panoulas, {Vasileios F.} and Janine P{\"o}ss and Alexander Rosenberg and Schaubroeck, {Hannah A.I.} and Benedikt Schrage and Guido Tavazzi and Thomas Vanassche and Leen Vercaemst and Dirk Vlasselaers and Pascal Vranckx and Jan Belohlavek and Gorog, {Diana A.} and Kurt Huber and Alexandre Mebazaa and Bart Meyns and Federico Pappalardo and Scandroglio, {Anna M.} and Stone, {Gregg W.} and Dirk Westermann and Alaide Chieffo and Susanna Price and Christophe Vandenbriele",

note = "{\textcopyright} 2023 The Author(s). This is an open access article distributed under the terms of the Creative Commons Attribution License (CC BY), https://creativecommons.org/licenses/by/4.0/",

year = "2023",

month = jul,

day = "24",

doi = "10.1016/j.jcin.2023.05.043",

language = "English",

volume = "16",

pages = "1707--1720",

journal = "JACC: Cardiovascular Interventions",

issn = "1936-8798",

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Van Edom, CJ, Gramegna, M, Baldetti, L, Beneduce, A, Castelein, T, Dauwe, D, Frederiks, P, Giustino, G, Jacquemin, M, Janssens, SP, Panoulas, VF, Pöss, J, Rosenberg, A, Schaubroeck, HAI, Schrage, B, Tavazzi, G, Vanassche, T, Vercaemst, L, Vlasselaers, D, Vranckx, P, Belohlavek, J, Gorog, DA, Huber, K, Mebazaa, A, Meyns, B, Pappalardo, F, Scandroglio, AM, Stone, GW, Westermann, D, Chieffo, A, Price, S & Vandenbriele, C 2023, 'Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach', JACC: Cardiovascular Interventions, vol. 16, no. 14, pp. 1707-1720. https://doi.org/10.1016/j.jcin.2023.05.043

TY - JOUR

T1 - Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach

AU - Van Edom, Charlotte J.

AU - Gramegna, Mario

AU - Baldetti, Luca

AU - Beneduce, Alessandro

AU - Castelein, Thomas

AU - Dauwe, Dieter

AU - Frederiks, Pascal

AU - Giustino, Gennaro

AU - Jacquemin, Marc

AU - Janssens, Stefan P.

AU - Panoulas, Vasileios F.

AU - Pöss, Janine

AU - Rosenberg, Alexander

AU - Schaubroeck, Hannah A.I.

AU - Schrage, Benedikt

AU - Tavazzi, Guido

AU - Vanassche, Thomas

AU - Vercaemst, Leen

AU - Vlasselaers, Dirk

AU - Vranckx, Pascal

AU - Belohlavek, Jan

AU - Gorog, Diana A.

AU - Huber, Kurt

AU - Mebazaa, Alexandre

AU - Meyns, Bart

AU - Pappalardo, Federico

AU - Scandroglio, Anna M.

AU - Stone, Gregg W.

AU - Westermann, Dirk

AU - Chieffo, Alaide

AU - Price, Susanna

AU - Vandenbriele, Christophe

PY - 2023/7/24

Y1 - 2023/7/24

N2 - Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.

AB - Percutaneous ventricular assist devices (pVADs) are increasingly being used because of improved experience and availability. The Impella (Abiomed), a percutaneous microaxial, continuous-flow, short-term ventricular assist device, requires meticulous postimplantation management to avoid the 2 most frequent complications, namely, bleeding and hemolysis. A standardized approach to the prevention, detection, and treatment of these complications is mandatory to improve outcomes. The risk for hemolysis is mostly influenced by pump instability, resulting from patient- or device-related factors. Upfront echocardiographic assessment, frequent monitoring, and prompt intervention are essential. The precarious hemostatic balance during pVAD support results from the combination of a procoagulant state, due to critical illness and contact pathway activation, together with a variety of factors aggravating bleeding risk. Preventive strategies and appropriate management, adapted to the impact of the bleeding, are crucial. This review offers a guide to physicians to tackle these device-related complications in this critically ill pVAD-supported patient population.

U2 - 10.1016/j.jcin.2023.05.043

DO - 10.1016/j.jcin.2023.05.043

M3 - Article

SN - 1936-8798

VL - 16

SP - 1707

EP - 1720

JO - JACC: Cardiovascular Interventions

JF - JACC: Cardiovascular Interventions

IS - 14

ER -

Management of Bleeding and Hemolysis During Percutaneous Microaxial Flow Pump Support A Practical Approach

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