Impella CP Dislodgment, Swap, or Removal: Current Practices.

: The Impella CP (ICP) catheter (Abiomed) offers hemodynamic superiority over the intra-aortic balloon pump. However, device-specific issues are occasionally encountered, especially when long-term mechanical circulatory support (MCS) is required. These include ICP dislodgment, ICP mechanical failure, and the need to remove the ICP while maintaining arterial access to either insert a new MCS device or to perform suture-based arteriotomy site closure. We offer a case in which ICP-based MCS involved ICP distal dislodgment, kinking of the ICP catheter, and removal of the device in a coagulopathic and thrombocytopenic patient. The literature regarding potential solutions to these problems is reviewed. Future ICP design is likely to reduce the frequency and complexity of such events and facilitate the management of these scenarios. This is the first report of a novel method to address ICP kinking dislodgment that did not respond to conventional repositioning maneuvers.