Patient Transport with the Automated Impella Controller
The ABIOMED logo, ABIOMED, Impella, Impella 2.5, Impella 5.0, Impella CP, Impella LD, and Impella RP, are registered trademarks of Abiomed, Inc. in the U.S.A. and in certain foreign countries. Recovering hearts. Saving lives. is a trademark of ABIOMED, Inc.
TABLE OF CONTENTS 1 WARNINGS... 2 PURPOSE OF THESE INSTRUCTIONS... 3 INDICATION AND SAFETY INFORMATION - LEFT-SIDED SUPPORT... 3 Protected PCI... 3 Cardiogenic Shock... 3 Contraindications... 4 Potential Adverse Events... 4 INDICATION AND SAFETY INFORMATION - RIGHT-SIDED SUPPORT... 4 Indication for Use... 4 Contraindications... 4 Potential Adverse Events... 5 FAA ADVISORY... 5 ABOUT THE IMPELLA HEART PUMP... 6 PATIENT TRANSPORT WITH THE IMPELLA SYSTEM... 6 IMPORTANT CONSIDERATIONS... 7 Battery Operation... 7 TRANSPORT WITH THE AUTOMATED IMPELLA CONTROLLER... 8 SECURING THE AUTOMATED IMPELLA CONTROLLER... 8 TRANSFERRING SUPPORT FROM THE AUTOMATED IMPELLA CONTROLLER TO A NEW AUTOMATED IMPELLA CONTROLLER... 9 How to Switch Support... 9 Patient Management Checklist... 10 ELECTRICAL SAFETY TESTING AND EMISSIONS TABLES... 10 Transport with the Automated Impella Controller 1
WARNINGS Warnings alert you to situations that can cause death or serious injury. The red symbol appears before warning messages. During transport, the Automated Impella Controller (AIC) may be exposed to stronger electromagnetic disturbance than during in-hospital use. Strong electromagnetic disturbance may cause the Automated Impella Controller to display soft button menu selections that were not selected by the user. Operators should be aware that, under these conditions, the operating parameters are not affected. No user intervention is required. Monitor Impella Catheter flow and patient hemodynamics to confirm normal operation. The condition will resolve itself once the Automated Impella Controller is no longer exposed to the disturbance. NOTE: The EMC tables in the Electromagnetic Compatibility (EMC) section and other guidelines that are included in this manual provide information to the customer or user that is essential in determining the suitability of the equipment or system for the electromagnetic environment of use, and in managing the electromagnetic environment of use permit the equipment or system to perform to its intended use without disturbing other equipment and systems or non-medical electrical equipment. For the electromagnetic testing shown in tables in the Electromagnetic Compatibility (EMC) section, the AIC Essential Performance was specified as: during the entire testing period, the AIC continues to provide support to the patient. 2 User Manual
PURPOSE OF THESE INSTRUCTIONS These instructions are designed for healthcare professionals to facilitate transport of patients supported with the Automated Impella Controller from one medical facility to another. This manual contains clinical and technical information to guide healthcare professionals before, during, and after transport. INDICATION AND SAFETY INFORMATION - LEFT-SIDED SUPPORT Protected PCI The Impella 2.5 and Impella CP Systems are temporary ( 6 hours) ventricular support devices indicated for use during high-risk percutaneous coronary interventions (PCI) performed in elective or urgent, hemodynamically stable patients with severe coronary artery disease and depressed left ventricular ejection fraction, when a heart team, including a cardiac surgeon, has determined high-risk PCI is the appropriate therapeutic option. Use of the Impella 2.5 and Impella CP Systems in these patients may prevent hemodynamic instability, which can result from repeat episodes of reversible myocardial ischemia that occur during planned temporary coronary occlusions and may reduce peri- and post-procedural adverse events. Cardiogenic Shock The Impella 2.5, Impella CP, Impella 5.0, and Impella LD Catheters, in conjunction with the Automated Impella Controller (collectively, Impella System Therapy ), are temporary ventricular support devices intended for short term use ( 4 days for the Impella 2.5 and Impella CP, and 6 days for the Impella 5.0, and Impella LD) and indicated for the treatment of ongoing cardiogenic shock that occurs immediately (< 48 hours) following acute myocardial infarction or open heart surgery as a result of isolated left ventricular failure that is not responsive to optimal medical management and conventional treatment measures (including volume loading and use of pressors and inotropes, with or without IABP). The intent of Impella System Therapy is to reduce ventricular work and to provide the circulatory support necessary to allow heart recovery and early assessment of residual myocardial function. Transport with the Automated Impella Controller 3
Contraindications The Impella 2.5, Impella CP, Impella 5.0 and Impella LD are contraindicated for use with patients experiencing any of the following conditions: Mural thrombus in the left ventricle; Presence of a mechanical aortic valve or heart constrictive device; Aortic valve stenosis/calcification (equivalent to an orifice area of 0.6 cm2 or less); Moderate to severe aortic insufficiency (echocardiographic assessment graded as +2); Severe peripheral arterial disease precluding placement of the Impella System; Significant right heart failure*; Combined cardiorespiratory failure*; Presence of an Atrial or Ventricular Sepal Defect (including post-infarct VSD)*; Left ventricular rupture*; Cardiac tamponade* Potential Adverse Events Acute renal dysfunction, Aortic valve injury, Bleeding, Cardiogenic shock, Cerebral vascular accident/stroke, Death, Hemolysis, Limb ischemia, Myocardial infarction, Renal failure, Thrombocytopenia and Vascular injury In addition to the risks above, there are other WARNINGS and PRECAUTIONS associated with Impella devices. Visit: www.protectedpci.com/hcp/information/isi and www.cardiogenicshock.com/hcp/information/isi to learn more. INDICATION AND SAFETY INFORMATION - RIGHT-SIDED SUPPORT Indication for Use The Impella RP is indicated for providing circulatory assistance for up to 14 days in pediatric or adult patients with a body surface area 1.5 m2 who develop acute right heart failure or decompensation following left ventricular assist device implantation, myocardial infarction, heart transplant, or openheart surgery. Contraindications The Impella RP is contraindicated for use with patients experiencing any of the following conditions: Pulmonary artery wall disorders precluding *This condition is a contraindication for the cardiogenic shock indication only. 4 User Manual
placement or correct positioning of the Impella RP device; Anatomic conditions precluding insertion of the pump; Tricuspid or pulmonic valve abnormalities including: mechanical valves, severe stenosis or regurgitation; Mural thrombus of the right atrium or vena cava; Other illnesses or therapy requirements precluding use of the pump; Presence of a vena cava filter or caval interruption device, unless there is clear access from the femoral vein to the right atrium that is large enough to accommodate a 22 Fr catheter. Potential Adverse Events Arrhythmia, Atrial fibrillation, Bleeding, Cardiac tamponade, Cardiogenic shock, Death, Device Malfunction, Hemolysis, Hepatic failure, Insertion site infection, Perforation, Phlegmasia cerulea dolens (a severe form of deep venous thrombosis), Pulmonary valve insufficiency, Respiratory dysfunction, Sepsis, Thrombocytopenia, Thrombotic vascular (noncentral nervous system) complication, Tricuspid valve injury, Vascular injury, Venous thrombosis, Ventricular fibrillation and/or tachycardia. In addition to the risks above, there are other WARNINGS and PRECAUTIONS associated with Impella RP. Visit: www.abiomed.com/impella/impella-rp to learn more. FAA ADVISORY The Automated Impella Controller has been subjected to, and passed the EMC/EMI tests as specified in IEC 60601-1-2 (General requirements for safety Collateral standard: Electromagnetic compatibility Requirements and tests). Refer to the Electrical Safety Testing Appendix in this manual for more information. The Automated Impella Controller has not been tested against the requirements for conducted emissions of RTCA/DO-160G section 21.4 and has not been tested for radiated emissions per RTCA/DO-160G section 21.5. Abiomed recommends that air transport carriers follow the guidance FAA Advisory Circular AC No: 91-21.1B. Section 8-a of FAA Advisory Circular AC No: 91-21.1B states: Equipment tested and found to exceed the section 21, Category M, emission levels are required to be evaluated in the operator s M-PED selected model aircraft for electromagnetic interference (EMI) and radio frequency interference (RFI). All navigation, communication, engine, and flight control systems will be operating in the selected aircraft during the evaluation. Transport with the Automated Impella Controller 5
ABOUT THE IMPELLA HEART PUMP The Impella 2.5, Impella CP, Impella 5.0 Impella LD are intravascular microaxial blood pumps that support a patient s circulatory system. The Impella heart pump is inserted through the femoral or axillary artery into the left ventricle or, in the case of the LD, surgically via the ascending aorta. When properly positioned, the Impella delivers blood from the inlet area, which sits inside the left ventricle, through the cannula, to the outlet opening in the ascending aorta. Users monitor the correct positioning and functioning of the Impella on the display screen of the Automated Impella Controller. The Impella RP is an intravascular microaxial blood pump that support a patient s pulmonary circulation. It pushes blood from the IVC into the pulmonary artery, bypassing the right ventricle. PATIENT TRANSPORT WITH THE IMPELLA SYSTEM The Automated Impella Controller and Impella Catheters have been cleared by the FDA for hospital-to-hospital transport via ambulance, helicopter, or fixed-wing aircraft. To use the system during transport you must understand and follow the Impella instructions for use. The transport team should include one person fully trained in the use of the Automated Impella Controller and Impella Catheter. Abiomed encourages the establishment of a relationship between outlying centers (SPOKE facilities) and tertiary-care centers (HUB facilities). Criteria for accepting patients into a program should be determined between hospitals in advance of the need for a transfer. 6 User Manual
IMPORTANT CONSIDERATIONS 1. Planning is critical to success. Abiomed representatives can help with planning for transport. They can be contacted 24 hours a day at 1-800-422-8666. 2. Abiomed recommends that air transport carriers follow the guidance FAA Advisory Circular AC No: 91-21.1B. 3. The Automated Impella Controller should be fully charged prior to transport. Keep the controller connected to AC power (or an AC inverter) whenever possible. Prior to connecting the Impella Automated Controller to the transport vehicle s inverter or power source, ensure that the aircraft or ambulance is up and running first. 4. Do not stress the connector cable from the controller to the Impella Catheter. Such tension could move the catheter out of correct position and compromise patient circulatory support. 5. Carefully monitor purge pressures during changes in altitude. 6. The controller should be positioned to allow easy access to the display screen and soft buttons to view alarms and make any necessary changes. 7. Maintain ACTs between 160 and 180 or at the level recommended by the physician responsible for the patient. 8. If possible, place the controller and the red Impella plug at the level of the patient s heart during transport. 9. Decrease the flow rate to P2 if CPR is necessary. 10. For additional transport training, please visit: www.abiomedtraining.com Battery Operation The Automated Impella Controller is designed to operate for at least 60 minutes on battery power. Transport teams should take this into consideration when planning the transport. If the total transport time is expected to include more than 60 minutes during which the system will be disconnected from AC power, arrangements should be made to use a vehicle with a built-in DC to AC power inverter. Transport with the Automated Impella Controller 7
TRANSPORT WITH THE AUTOMATED IMPELLA CONTROLLER 1. Unplug the Automated Impella Controller from AC power. 2. Rotate the T-knobs to unlock the controller from the cart. 3. Lift the controller off the cart using the blue handle. 4. Place the controller on a flat surface (seat, bench, shelf, or stretcher) or hang the controller on the end of the stretcher using the bed mount. 5. Remove the purge solution from the IV pole on the cart and place it on the IV pole of the stretcher or transport vehicle. 6. Secure the controller. If the controller is left unsecured, it can become a dangerous projectile inside the transport vehicle or aircraft. SECURING THE AUTOMATED IMPELLA CONTROLLER Options for securing the Impella System during transport will vary by transport provider. Transport providers should take into consideration their particular vehicle, stretcher design, and accessory mounting options when planning to transport a patient supported by the Impella System. 1. The Automated Impella Controller has a bed mount on the back of the housing that may be used to hang the controller on the stretcher while the patient is transported inside the hospital. 2. Straps may be used to secure the Automated Impella Controller to a flat surface in the transport vehicle. 3. The bed mount may be used as a loop through which to secure the straps. 8 User Manual
TRANSFERRING SUPPORT FROM THE AUTOMATED IMPELLA CONTROLLER TO A NEW AUTOMATED IMPELLA CONTROLLER Follow these steps to transition from the sending hospital s Automated Impella Controller to the new Automated Impella Controller after transport. How to Switch Support 1 Prepare 2 Switch A. Confirm that the backup controller is powered on and ready. A. Disconnect the yellow luer connector from the Impella Catheter to release the pressure in the purge cassette. B. Reconnect the yellow luer connector to the Impella Catheter. C. Transfer the purge cassette and purge solution from the original controller to the backup controller.* D. Remove the white connector cable from the original controller and plug it into the catheter plug on the front of the backup controller.* 3 Confirm A. Once the Impella Catheter is connected to the backup controller, a message will appear on the screen asking you to confirm restarting the Impella Catheter at the previously set P-level. B. Press OK within 10 seconds to confirm restarting the Impella Catheter at the previously set P-level. C. Press PURGE SYSTEM on the backup controller, select Change Purge Fluid and complete the procedure to get accurate purge value after change to the backup controller. *Note: Purge fluid can be moved before or after the white connector cable. Transport with the Automated Impella Controller 9
Patient Management Checklist Check each of the following once patient support has been transferred: Confirm Impella placement using echocardiography. Tighten the Tuohy bore on the Impella Catheter to prevent catheter migration. (Tighten all the way to the right) For patients supported with the Impella 2.5 or Impella CP Catheter, attach a saline pressure bag pressurized to 350 mmhg to the red sidearm and complete the Transfer to Standard Configuration under the PURGE SYSTEM menu. Contact the local team or the 24 hour clinical support line (1-800-422-8666) with any questions or concerns. ELECTRICAL SAFETY TESTING AND EMISSIONS TABLES TABLE 1: EMI Conducted and Radiated Emissions Country or Standard Test Description Test Standard 60601-1-2 Radiated emissions, 30 1000 MHz, Group 1 Class A 60601-1-2 Conducted emissions, 150 khz 30 MHz, Group 1 Class A CISPR 11 / EN55011 CISPR 11 / EN55011 US FCC 47CFR 15C Cert Title 47 CFR Part 15 Subpart C Intentional Radiator Canada RSS 210 Issue: 7 June 2007 A2.6 Low Power License Exempt Radiocommunication Devices (All Frequency Bands) Canada RSS-GEN Issue: 2 June 2007 General Requirements and Information for the Certification of Radiocommunication Equipment 10 User Manual
TABLE 2: EMC Tests and Standards IEC 60601-1-2 Test Description Test Standard Harmonic current emissions; Class A IEC 61000-3-2 Limitation of voltage fluctuations and flicker IEC 61000-3-3 Electromagnetic radiated field immunity IEC 61000-4-3 Electromagnetic conducted field immunity IEC 61000-4-6 Voltage dips and interruptions on AC power mains IEC 61000-4-11 Magnetic fields immunity IEC 61000-4-8 Electrically fast transients on AC power mains IEC 61000-4-4 Surge on AC power mains IEC 61000-4-5 Electrostatic discharge IEC 61000-4-2 TABLE 3: Automated Impella Controller Electrical Specifications Parameter Temperature Specification Operating: 10 C to 40 C (50 F to 104 F) Storage: -15 C to 50 C (5 F to 122 F) Relative humidity Operating: 95% Storage: 95% Atmospheric pressure Dimensions Weight Maintenance and repair interval AC operation Internal battery operation Characteristic values Electrical system Operating: 8000 ft (750 hpa) to -1000 ft (1050 hpa) Storage: 18,000 ft (500 hpa) to -1000 ft (1050 hpa) Height: 351 mm (13.8 in), Width: 443 mm (17.4 in), Depth: 236 mm (9.3 in) Maximum: 11.8 kg (26.1 lbs) 12 months (work must be performed by technicians authorized by Abiomed) 100-230 V AC (nominal); 47-63 Hz; 1.1 A 14.4 V DC (nominal); lithium ion Max. power consumption under load 120 VA 9.7 fuses; 2 Amp. 250 V. 5 mm x 20 mm, slow blow fuses Run time without AC power (full charged batteries) 60 minutes minimum (charging duration of at least 5 hours) Installation in accordance with pertinent regulations is required for use in medical facilities (eg, VDE 0100, VDE 0107, or ICE stipulations). Observe country-specific regulations and national deviations. Transport with the Automated Impella Controller 11
The Automated Impella Controller is intended for use in the electromagnetic environment specified below. The customer or user of the Automated Impella Controller should ensure that it is used in such an environment. TABLE 4: Guidance and manufacturer s declaration - emissions, all equipment and systems Emissions Test Compliance Electromagnetic Enforcement - Guidance RF Emissions CISPR 11 Harmonics IEC 61000-3-2 Flicker IEC 61000-3-3 Group 1 Class A Class A Complies The Automated Impella Controller uses RF energy only for its internal function. Therefore, its RF emissions are very low and are not likely to cause any interference in nearby electronic equipment. The Automated Impella Controller is suitable for use in all establishments other than domestic and those directly connected to the public low-voltage power supply network that supplies buildings used for domestic TABLE 5: RFID Transmitter / Receiver Specifications Frequency 13.56MHz Receiver Bandwidth Effective Radiated Power Modulation 14 khz 30 nw ASK 12 User Manual
TABLE 6: Guidance and manufacturer s declaration - immunity Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Enforcement - Guidance Electrostatic Discharge (ESD) IEC 61000-4-2 ±6 kv contact ±8 kv air ±8 kv contact ±15 kv air The relative humidity should be at least 5%. Electrical Fast Transient/ burst IEC 61000-4-4 ±2 kv Mains ±1 kv for input/ output lines ±2 kv Mains ±1 kv for input/ output lines Mains power quality should be that of a typical commercial or hospital environment. Surge IEC 61000-4-5 ±1 kv Differential ±2 kv Common ±1 kv Differential ±2 kv Common Mains power quality should be that of a typical commercial or hospital environment. Voltage dips, short interruptions and voltage variations on power supply input lines IEC 61000-4-11 > 95% dip for 0.5 cycle 60% dip for 5 cycles 30% dip for 25 cycles > 95% dip for 5 seconds > 95% dip for 0.5 cycle 60% dip for 5 cycles 30% dip for 25 cycles > 95% dip for 5 seconds Mains power quality should be that of a typical commercial or hospital environment. If the user of the Automated Impella Controller requires continued operation during power mains interruptions, it is recommended that the Automated Impella Controller be powered from an uninterruptible power supply or battery. Power Frequency 50/60 Hz Magnetic Field IEC 61000-4-8 3 A/m 3 A/m Power frequency magnetic fields should be that of a typical location in a typical commercial or hospital environment. Transport with the Automated Impella Controller 13
Portable and mobile RF communications equipment should be separated from the Automated Impella Controller by no less than the recommended separation distances calculated/listed in Table 7 (where P is the maximum power rating in watts and d is the recommended separation distance in meters). Field strengths from fixed transmitters, as determined by an electromagnetic site survey (a), should be less than the compliance level in each frequency range (b). Interference may occur in the vicinity of equipment marked with the following symbol: TABLE 7: Guidance and manufacturer s declaration - emissions, equipment and systems that are life-supporting Immunity Test IEC 60601 Test Level Compliance Level Electromagnetic Enforcement - Guidance Conducted RF IEC 61000-4-6 10 Vrms 150 khz to 80 MHz 10 Vrms d = 0.35 P Radiated RF IEC 61000-4-3 10 V/m 80 MHz to 2.5 GHz 20 V/m d = 0.6 P 80 to 800 MHz d = 1.2 P 800 MHz to 2.5 GHz NOTE 1: At 80 MHz and 800 MHz, the higher frequency range applies. NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people. (a) Field strengths from fixed transmitters, such as base stations for radio (cellular/ cordless) telephones and land mobile radios, amateur radio, AM and FM radio broadcast and TV broadcast cannot be predicted theoretically with accuracy. To assess the electromagnetic environment due to fixed RF transmitters, an electromagnetic site survey should be considered. If the measured field strength in the location in which the Impella Controller is used exceeds the applicable RF compliance level above, the Impella Controller should be observed to verify normal operation. If abnormal performance is observed, additional measures may be necessary, such as re-orienting or relocating the Impella Controller. (b) Over the frequency range 150 khz to 80 MHz, field strengths should be less than 10 V/m. 14 User Manual
The Automated Impella Controller is intended for use in the electromagnetic environment in which radiated disturbances are controlled. The customer or user of the Automated Impella Controller can help prevent electromagnetic interference by maintaining a minimum distance between portable and mobile RF communications equipment and the Automated Impella Controller as recommended below, according to the maximum output power of the communications equipment. TABLE 8: Recommended separation distances between portable and mobile RF communications equipment and the Automated Impella Controller, equipment and systems that are life-supporting Rated Maximum Output Recommended Separation Distances for the Automated Impella Controller (m) Output Power of Transmitter (Watts) 150 KHz to 80 MHz d = 0.35 P 80 to 800 MHz d = 0.6 P 800 MHz to 2.5 GHz d = 1.2 P 0.01 0.04 0.06 0.12 0.1 0.11 0.19 0.38 1 0.35 0.6 1.2 10 1.11 1.9 3.8 100 3.5 6.0 12 NOTE 1: At 80 MHz and 800 MHz, the separation distance for the higher frequency range applies. NOTE 2: These guidelines may not apply in all situations. Electromagnetic propagation is affected by absorption and reflection from structures, objects, and people. For transmitters rated at a maximum output power not listed above, the recommended separation distance (d) in meters (m) can be determined using the equation applicable to the frequency of the transmitter, where P is the maximum output power rating of the transmitter in watts (W) according to the transmitter manufacturer. Transport with the Automated Impella Controller 15
IMP-1255-16 Clinical support 24 hours per day, 7 days a week: 1-800-422-8666 (US) www.abiomed.com For Transport Training, visit www.abiomedtraining.com Abiomed, Inc. 22 Cherry Hill Drive Danvers, Massachusetts 01923 USA Voice: 978-777-5410 Facsimile: 978-777-8411 Email: marketing@abiomed.com 0086