Van Edom Charlotte, Van Puyvelde Tim, Jacobs Steven, Vandenbriele Christophe
Department of Cardiovascular Sciences, University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
Department of Cardiovascular Diseases, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium.
Eur Heart J Case Rep. 2023 Jan 11;7(1):ytad022. doi: 10.1093/ehjcr/ytad022. eCollection 2023 Jan.
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.
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.
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.
使用Impella™设备进行经皮机械循环支持（pMCS）意味着要启动全身抗凝以预防全身血栓形成并发症，并使用冲洗液以防止设备堵塞。传统上，这两者均使用普通肝素（UFH）。2022年4月，在UFH存在禁忌证的情况下，基于碳酸氢盐的冲洗液（BBPS）作为葡萄糖溶液中UFH的替代品获得了美国食品药品监督管理局的批准。
我们报告了一例73岁女性患者，因心源性休克入住心脏重症监护病房，需要通过腋动脉置入Impella CP™进行pMCS升级。当她出现严重血胸时，所有UFH均停用，冲洗液改为BBPS-葡萄糖溶液，冲洗压力未增加，也未发生溶血。出血停止，2天后患者成功撤离Impella™。
本文报告了自2022年4月美国食品药品监督管理局批准以来，首例在Impella CP™支持下发生大出血的患者改用BBPS的病例。在本病例中，改用BBSP并输注血小板和鱼精蛋白后出血停止。
