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Use of a Novel Bicarbonate-Based Impella 5.5 Purge Solution in a Coagulopathic Patient
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  • Kyle Simonsen,
  • Brady Gunn,
  • Amber Malhotra,
  • Daniel Beckles,
  • Michael Koerner,
  • Giuseppe Tavilla,
  • Ramachandra Reddy
Kyle Simonsen
Baylor Scott & White Medical Center Temple

Corresponding Author:[email protected]

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Brady Gunn
A T Still University
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Amber Malhotra
Scott and White Memorial Hospital
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Daniel Beckles
Baylor Scott & White Medical Center Temple
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Michael Koerner
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Giuseppe Tavilla
Baylor Scott & White Medical Center Temple
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Ramachandra Reddy
Scott and White Memorial Hospital
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Abstract

The Impella 5.5 with SmartAssist (Abiomed; Danvers, MA) is a life-saving treatment option in acute heart failure which utilizes a continuous heparin purge solution to prevent thrombosis. In patients with contraindications to heparin, alternative anticoagulation strategies are required. We describe the stepwise management of anticoagulation in a coagulopathic patient with persistent cardiogenic shock following a coronary artery bypass procedure who underwent Impella 5.5 placement. A direct thrombin inhibitor-based purge solution was utilized while evaluating for heparin-induced thrombocytopenia. Use of a novel bicarbonate-based purge solution (BBPS) was successfully used due to severe coagulopathy. There were no episodes of pump thrombosis or episodes of severe bleeding on the BBPS and systemic effects of alkalosis and hypernatremia were minimal.
24 Aug 2021Submitted to Journal of Cardiac Surgery
25 Aug 2021Submission Checks Completed
25 Aug 2021Assigned to Editor
09 Sep 2021Review(s) Completed, Editorial Evaluation Pending
10 Sep 2021Editorial Decision: Accept
Dec 2021Published in Journal of Cardiac Surgery volume 36 issue 12 on pages 4773-4775. 10.1111/jocs.16008