Wednesday, October 1, 2014

Impella device use without Heparin

Most heart assist devices requires Heparin. Here is an interesting case report.

*Impella Video as an addendum after reference

"A 58-year-old Asian man with no history of cardiac disease, hypertension, or diabetes mellitus had an AMI and subsequent cardiogenic shock. He was started on dopamine and norepinephrine and transferred to a tertiary care center for rescue percutaneous coronary intervention (PCI). Given that his artery was patent with Thrombolysis In Myocardial Infarction 3 flow, PCI was not attempted. He had an ejection fraction of 25% and mid-distal anteroseptal akinesis. He was transferred to the intensive care unit on intra-aortic balloon pump (IABP) support. The patient’s condition continued to deteriorate, and an Impella LP 2.5 pVAD was inserted for additional hemodynamic support and as a bridge to definitive revascularization. To reduce the potential for medication error and decrease the patient’s bleeding risk, the purge solution was changed to 20% dextrose injection without heparin and continued at a rate of 15 mL/hr. The patient’s hemodynamic values improved, and the pVAD and IABP were continued for the next five days. The patient was successfully anticoagulated with i.v. heparin throughout the remainder of pVAD support. While the patient did develop hemolytic anemia during his device support, there were no thrombotic or bleeding complications."


Douglas L. Jennings, Carrie W. Nemerovski and Akshay Khandelwal - Extended use of a percutaneous left-ventricular assist device without a heparin-based purge solution,  American Journal of Health-System Pharmacy November 1, 2010 vol. 67 no. 21 1825-1828

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