• Bridget K Dittman.
• Bridget K. Dittman is a clinical nurse practice leader in the intensive care unit at Einstein Center Montgomery in East Norriton, Pennsylvania. dittmanb@einstein.edu.
• Crit Care Nurse. 2019 Apr 1; 39 (2): 15-28.

IntroductionOnly a few cases of biventricular cardiogenic shock have been treated with Impella circulatory assist devices in the United States.Clinical FindingsA 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.DiagnosisEchocardiography revealed dilated cardiomyopathy and biventricular failure with an ejection fraction of 15%. Results of an endomyocardial biopsy confirmed the diagnosis of myocarditis.InterventionsAfter 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.OutcomesThe 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.ConclusionThis 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.©2019 American Association of Critical-Care Nurses.

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