2025 Southeastern Residency Conference

Title: Comparison of purge reliability between heparin- and bicarbonate-based purge solutions during Impella support
Author Names: Jessica Donald, Breanne Mefford, Bryan Love, Jenna Cox
 
Background: Impella heart pumps are temporary mechanical circulatory support (MCS) devices used beyond procedural settings in patients with cardiogenic shock to support heart function by unloading the right or left ventricle. A solution is utilized to suppress denatured protein or thrombus deposition within the purge gaps of the Impella device. Heparin-based purge solutions are recommended by the device manufacturer, who advises against the use of non-heparin anticoagulants within the purge solution. While direct thrombin inhibitors were initially explored as a purge solution option for patients with heparin-induced thrombocytopenia, pump failures and other complications have been documented with their use. Sodium bicarbonate has emerged as an alternative, stabilizing the pump without affecting systemic heparin levels, simplifying anticoagulation management. Although FDA-approved in April 2022 for patients intolerant to heparin, data related to its clinical use remains limited.


Methods: This retrospective, observational cohort study aims to assess the efficacy of a sodium bicarbonate-based purge solution as an alternative to heparin-based purge solutions for patients receiving Impella support. The primary outcome will focus on purge reliability, defined as a composite measure of: a 25% increase in purge pressure from baseline, and/or a 50% reduction in purge flow rate (for index flow rates >15 mL/hr) or a 30% reduction (for index flow rates ≤15 mL/hr). Secondary outcomes will include the individual components of the primary composite outcome, along with the use of alteplase in the purge solution, as well as variations in purge flow rates and pressures.
 
Results: In Progress
 
Conclusion: In Progress