PMID- 36727126
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230203
IS  - 2514-2119 (Electronic)
IS  - 2514-2119 (Linking)
VI  - 7
IP  - 1
DP  - 2023 Jan
TI  - Switch to a bicarbonate-based Impella CP purge solution in a patient with 
      haemothorax: a case report.
PG  - ytad022
LID - 10.1093/ehjcr/ytad022 [doi]
LID - ytad022
AB  - BACKGROUND: Percutaneous mechanical circulatory support (pMCS) by an Impella 
      device implies the initiation of systemic anticoagulation to prevent systemic 
      thrombotic complications and a purge fluid to prevent device blockage. 
      Traditionally, unfractionated heparin (UFH) was used for both. In April 2022, the 
      use of bicarbonate-based purge solution (BBPS) as an alternative to UFH in 
      dextrose solution was approved by the Food and Drug Administration in case of 
      contraindications for UFH. CASE SUMMARY: We present the case of a 73-year-old 
      female that was admitted to the cardiac intensive care unit with cardiogenic 
      shock, requiring upgrade with pMCS by an axillary Impella CP. When she developed 
      a severe haemothorax, all UFH was stopped and the purge was switched to 
      BBPS-dextrose solution without increase in purge pressures nor development of 
      haemolysis. The bleeding stagnated and the patient could be weaned from the 
      Impella after 2 days. DISCUSSION: Here, we present the first case report of the 
      switch to BBPS in an Impella CP supported patient with major bleeding since the 
      FDA approval in April 2022. The switch to BBSP in addition with the 
      administration of platelets and protamine resulted in cessation of the bleeding 
      in this case.
CI  - (c) The Author(s) 2023. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Van Edom, Charlotte
AU  - Van Edom C
AUID- ORCID: 0000-0003-2830-624X
AD  - Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 
      Leuven, Belgium.
FAU - Van Puyvelde, Tim
AU  - Van Puyvelde T
AD  - Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 
      49, 3000 Leuven, Belgium.
FAU - Jacobs, Steven
AU  - Jacobs S
AUID- ORCID: 0000-0002-8083-8916
AD  - Department of Cardiac Surgery, Unversity Hospitals Leuven, Herestraat 49, 3000 
      Leuven, Belgium.
AD  - Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 
      Leuven, Belgium.
FAU - Vandenbriele, Christophe
AU  - Vandenbriele C
AUID- ORCID: 0000-0001-5151-6400
AD  - Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 
      Leuven, Belgium.
AD  - Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 
      49, 3000 Leuven, Belgium.
AD  - Department of Adult Intensive Care, Royal Brompton and Harefield Hospitals, Guy's 
      and St Thomas' NHS Foundation Trust, Sydney St, London SW3 6NP, UK.
LA  - eng
PT  - Case Reports
DEP - 20230111
PL  - England
TA  - Eur Heart J Case Rep
JT  - European heart journal. Case reports
JID - 101730741
PMC - PMC9883732
OTO - NOTNLM
OT  - Bicarbonate
OT  - Bleeding
OT  - Case report
OT  - Mechanical circulatory support
OT  - Purge solution
COIS- Conflict of interest: None declared.
EDAT- 2023/02/03 06:00
MHDA- 2023/02/03 06:01
PMCR- 2023/01/11
CRDT- 2023/02/02 02:07
PHST- 2022/08/05 00:00 [received]
PHST- 2022/09/21 00:00 [revised]
PHST- 2023/01/09 00:00 [accepted]
PHST- 2023/02/02 02:07 [entrez]
PHST- 2023/02/03 06:00 [pubmed]
PHST- 2023/02/03 06:01 [medline]
PHST- 2023/01/11 00:00 [pmc-release]
AID - ytad022 [pii]
AID - 10.1093/ehjcr/ytad022 [doi]
PST - epublish
SO  - Eur Heart J Case Rep. 2023 Jan 11;7(1):ytad022. doi: 10.1093/ehjcr/ytad022. 
      eCollection 2023 Jan.