IP
Impella IQ
Percutaneous Ventricular Support Education
IQ Suite
For Educational Use Only · Not a Substitute for Institutional Protocols
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Impella IQ

Percutaneous ventricular support education for ICU nurses — device family, position signals, the purge system, alarms, complications, and weaning.

The one thing to take from this module: an aortic placement signal plus a pulsatile motor current means the pump straddles the valve. Either signal alone can look completely normal while the pump is doing nothing. Almost everything else here builds on that.
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Education Modules
Eight modules — physiology and unloading, patient selection, insertion, anticoagulation and hemolysis, nursing care, complications, right-sided support, weaning.
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Device Family
2.5, CP, 5.0, 5.5, LD, RP — flows, access routes, and what changes at the bedside for each.
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Position Signals
Placement signal and motor current side by side. Five patterns, including the malposition that looks completely normal.
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Purge System
Interactive purge-pressure explorer and the P-0 to P-9 support ladder.
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Alarms
Eleven console alarms — cause and nursing action for each.
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Calculators
Cardiac power output, PAPi, purge heparin contribution, MAP and pulse pressure.
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Clinical Cases
Three interactive cases with decision points and rationale.
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Weaning Readiness
Twelve-point checklist with saved progress.
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Knowledge Check
Eighteen questions with rationale for every answer.
Before You Start

This module teaches principles and pattern recognition. Device specifications, flow figures, French sizes, purge concentrations, anticoagulation targets, and positioning limits all vary by device generation, IFU revision, and institution. Values marked Verify are the ones most likely to differ from your practice.

Your institutional protocol and the current manufacturer IFU always take precedence over anything in this app.

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Education Modules

Eight modules covering Impella support from physiology to removal.

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Device Family

Tap any device to expand. Flows and catheter sizes vary by generation — verify against the current IFU.

All specifications on this page require verification against the current manufacturer IFU for the device in your institution. They change between product revisions, and this module is not a substitute for the IFU.
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Position Signals

Placement signal and motor current — read together, never separately.

The rule: aortic placement signal plus pulsatile motor current = correct position. Both are required. Tap any pattern for the physiology and the nursing action.
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The Purge System

What it does, what the pressure means, and what the P-levels do.

Why the Purge Exists

The impeller spins inside a motor housing. Without a barrier, blood would enter the motor and clot, destroying the pump. The purge system pushes a dextrose-and-heparin solution outward through the motor housing continuously, creating a pressure barrier that keeps blood out.

  • Purge fluid: dextrose (concentration adjusted to tune viscosity) with heparin Concentration is institutional — verify
  • Purge pressure: typically ~300–1100 mmHg Verify against IFU
  • Purge flow: typically ~2–30 mL/hr Verify against IFU
Never stop the purge. Not to troubleshoot, not to transport, not for a procedure. Without purge flow, blood enters the motor and the pump thromboses.
Viscosity is the control knob. Higher dextrose concentration = more viscous = higher purge pressure at a given flow. Lower concentration = lower pressure. This is how purge pressure is deliberately adjusted — and it is a physician/perfusion decision, not a bedside one.
Purge Pressure Explorer

Tap a pressure state to see causes and nursing actions.

LowNormal rangeHigh
P-Levels — The Support Ladder

The P-level sets impeller speed, and therefore flow. Tap any level.

Flow is a hemodynamic number, not just a setting. If a P-level is not producing its expected flow, the cause is usually preload, RV function, position, or afterload — not the pump.
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Console Alarms

Cause and nursing action for each alarm.

Before you troubleshoot the console, look at the patient. A large share of Impella alarms are caused by hip flexion, a log roll, a boost, a transfer, a cough, a rhythm change, or aggressive fluid removal. Reposition first — the alarm often resolves before anyone touches the device.
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Calculators

Educational tools. Verify all thresholds against institutional protocol.

Cardiac Power Output (CPO)

The strongest single hemodynamic predictor of mortality in cardiogenic shock.

Pulmonary Artery Pulsatility Index (PAPi)

The number behind unexplained suction alarms. An LV Impella cannot pump what the RV does not deliver.

Purge Heparin Contribution

Heparin the patient receives from the purge alone — before any systemic infusion is counted. This dose changes whenever the purge flow rate changes.

MAP & Pulse Pressure

On support, pulse pressure is a recovery signal — track the trend.

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Clinical Cases

Work through the decision points. Every answer gets a rationale.

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Weaning Readiness

A twelve-point checklist. Your progress is saved on this device.

How the Wean Works

Reduce the P-level one level at a time, observing at each step for a defined interval. Interval is institutional — verify

At each level, ask: is the MAP maintained? Is the pulse pressure widening? Are filling pressures stable? Is CPO maintained? Is lactate stable? Is urine output maintained? Any new suction alarms?

Do not wean to minimum support and park there. At very low flow, stasis and thrombus risk within the pump rises. Either progress to removal or go back up.
A failed wean is information, not a defeat. Going back up a level is a normal, expected part of the process.
Readiness Checklist
0 / 12 complete 0%
This checklist is an educational teaching aid. It is not a validated clinical decision tool and does not replace your institutional weaning protocol or the judgement of the treating team.
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Knowledge Check

Eighteen questions. Rationale on every answer.

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Sources & Scope

What this module is based on, and what it deliberately does not do.

Pending clinical review. This module has been drafted but has not yet completed formal clinical review or citation verification. Content marked Verify is specifically flagged as varying by device generation, IFU revision, or institution.
Key References
  1. Møller JE, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock (DanGer Shock). N Engl J Med. 2024. — The randomized trial underpinning the AMI-CS indication, and the source of the complication profile emphasized throughout this module.
  2. O'Neill WW, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention (PROTECT II). Circulation. 2012;126(14):1717–1727.
  3. Naidu SS, et al. SCAI SHOCK Stage Classification Expert Consensus Update. J Am Coll Cardiol. 2022;79(9):933–946.
  4. Abiomed. Impella Instructions for Use and Clinical Reference Manual — device-specific, for each of 2.5, CP, 5.0, 5.5, LD, RP. The authoritative source for all specifications, purge parameters, and positioning values.
  5. Rihal CS, et al. SCAI/ACC/HFSA/STS Clinical Expert Consensus Statement on the Use of Percutaneous Mechanical Circulatory Support Devices in Cardiovascular Care. J Am Coll Cardiol. 2015;65(19):e7–e26.
  6. Fincke R, et al. Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock. J Am Coll Cardiol. 2004;44(2):340–348. — The origin of the CPO < 0.6 W threshold.
  7. Korabathina R, et al. The pulmonary artery pulsatility index identifies severe right ventricular dysfunction in acute inferior myocardial infarction. Catheter Cardiovasc Interv. 2012;80(4):593–600. — The origin of PAPi.
Scope — What This Module Does Not Do
  • It does not replace manufacturer training or institutional credentialing on the device.
  • It does not give device-specific operating instructions. Console operation, purge setup, cassette changes, and de-airing are taught by your institution against the current IFU.
  • It does not provide anticoagulation protocols, ACT targets, or purge concentrations as orders. Those are institutional.
  • It does not cover management during cardiac arrest as a protocol — only the physiologic distinction from IABP. Follow your policy.
  • It teaches pattern recognition and the reasoning underneath it. That reasoning is durable; the numbers are not.
Related Modules in the ICU IQ Suite
  • IABP IQ — the other mechanical circulatory support device; timing, augmentation, and the physiologic contrast drawn throughout this module.
  • Hemodynamic IQ — PA catheter waveforms, CPO, PAPi, and the pressure measurements this module assumes you can obtain and interpret.
  • ECMO IQ — VA-ECMO physiology, and the LV loading problem that ECPELLA exists to solve.