Document Type

Conference Proceeding

Publication Date

6-1-2021

Publication Title

ASAIO journal

Abstract

Study: The Impella catheter is a transvalvular, micro-axial left ventricular assist device that provides temporary mechanical circulatory support and requires a heparin-containing purge solution to reduce the risk of biomaterial deposition in the purge gaps and also maintain proper pump function. For patients with suspected or confirmed heparin-induced thrombocytopenia (HIT), direct thrombin inhibitors (DTI) have been proposed as an alternative to heparin in the purge, but have been associated with pump failure requiring temporary tPA in the purge solution to normalize pump function. In this report, we review HIT patients supported with a sodium bicarbonate-based purge solution (BBPS).

Methods: Patients with suspected or confirmed HIT on Impella support using sodium bicarbonate (25 mEq in 1L D5W solution) in the purge from September 2020 to January 2021 were reviewed. Case data were obtained from Impella Quality (IQ) database for those supported with a BBPS and clinically suspected or confirmed HIT. Purge pressures and purge flows were evaluated from the Automated Impella Controller (AIC).

Results: Ten patients were supported with a BBPS during this period. Impella support was begun either with no anticoagulant (n=5), DTI (n=2), or heparin (n=3) and then switched to BBPS. Impella run time using a BBPS ranged from 1-14 days; five pumps had a run time with a BBPS > 10 days (Figure 1). Systemic DTI use was used in five cases along with a BBPS. No purge pathway thrombosis or bleeding events were observed, along with no changes in purge flow or purge pressures observed.

In conclusion, preliminary experience suggests the use of BBPS in the setting suspected or confirmed HIT patients supported with an Impella is safe and effective and may provide a useful therapeutic option for heparin intolerant patients. Future work should investigate mechanisms and purge reliability of BBPS in this setting.

Volume

67

Issue

Suppl 2

First Page

116

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.