Moretz J, Das S, Beavers C, Jennings D, Cox JF, DiDomenico R, Dunn S, To L, Trujillo T, Weeks P, and Corbett S. Bicarbonate-based Purge Solution As A Bleeding Reduction Strategy in Patients on Impella Support. ASAIO Journal 2021; 67(SUPPL 2):115.
Study: The Impella Catheters require a heparin-containing purge solution to maintain proper pump function by reducing the risk of biomaterial deposition in the purge gaps. A bicarbonate-based purge solution (BBPS) has been proposed as an alternative to a heparin-based purge solution. We review performance in patients supported to date with a BBPS (heparin-induced thrombocytopenia patients were excluded from this analysis). Methods: This review includes patients (n=26) supported using sodium bicarbonate (25 mEq/1L of D5W) in the purge from September 2020 to February 2021. These patients were supported with BBPS post-operatively where heparin in the purge was not desired or were transitioned to BBPS because of bleeding issues. Case data were collected from an internal database to develop the clinical narrative and cross-referenced against Impella Controller data logs to assess purge trends and pump function. Results: All pumps were switched to BBPS in the purge if not started with BBPS (Figure 1A). The average time to initiating BBPS was 1.6 days (excluding n=3 outliers where time to switching was >15 days). The average duration of support with BBPS was 5 days and a maximum duration of 22 days (Figure 1B). Figure 1C shows clinical indications for use. Purge pressure and purge flow remained stable while on BBPS (Figure 1D). In conclusion, this preliminary experience suggests the feasibility of using BBPS to maintain purge patency, ensure pump motor reliability, reduce bleeding risk, and simplify anticoagulation management. Use of a BBPS may be a safe and effective alternative to heparin in the purge for patients in which heparin is contraindicated or not feasible. More patient experience and analysis are needed to evaluate how bicarbonate compares to heparin in the purge for all patients.