Percutaneous Biventricular Mechanical Heart Support in Cardiogenic Shock: A Nursing Case Report

INTRODUCTION Only a few cases of biventricular cardiogenic shock have been treated with Impella circulatory assist devices in the United States. CLINICAL FINDINGS A 29-year-old man came to the emergency department because of cough, shortness of breath, fever, and chills. Initial assessment revealed hypotension; an elevated creatinine level of 2.1 mg/dL; and markedly elevated results on liver function tests, with alanine transaminase 5228 IU/L and aspartate aminotransferase 6200 IU/L. The patient's signs and symptoms met criteria for New York Heart Association class IV heart failure and associated poor prognosis for recovery. DIAGNOSIS Echocardiography revealed dilated cardiomyopathy and biventricular failure with an ejection fraction of 15%. Results of an endomyocardial biopsy confi rmed the diagnosis of myocarditis. INTERVENTIONS After unsuccessful treatment with inotropes, biventricular support was started with an Impella CP device in the left ventricle and an Impella RP device in the pulmonary artery. OUTCOMES The patient was maintained on support for 8 days and was discharged to home from the hospital after 27 days. Repeat echocardiography 90 days after discharge indicated improvement in ejection fraction to 40%. At follow-up 16 weeks after discharge, all signs and symptoms of heart failure had resolved. The patient has not had any inpatient readmissions to the hospital to date. CONCLUSION This case presents an opportunity for analysis of care activities and role responsibilities of bedside nurses in caring for this patient. Discussion of this case expands the literature describing nursing activities associated with caring for patients with Impella devices.