Bicarbonate Purge in Impella: Safety and Feasibility

Given a reasonable number of patients with contraindications to heparin, a safe and effective alternative to heparin as a purge fluid following Impella® temporary mechanical circulatory support implantation is desired. Here, we report the feasibility of a bicarbonate-based purge solution (BBPS) compared with a heparinized purge solution (HPS) without systemic anticoagulation in 43 Impella recipients between 2021 and 2023 at three centers in a single healthcare system. In a retrospective review of 43 consecutive Impella recipients, we compared major cardiovascular events (MACE), 30 day mortality, stroke, bleeding, and pump-adequate function between BBPS and HPS patients. Twenty patients on BBPS and 23 patients on HPS were included. They were supported on Impella 5.0 (n = 2), Impella 5.5 (n = 26), and Impella CP (n = 15) for a median of 7.3 days (interquartile range [IQR], 4.6-13.6). The prevalence of MACE, 30 day mortality, bleeding, stroke, and pump function was similar between groups. In this retrospective study, we found no differences in MACE, mortality at 30 days, stroke, bleeding, or pump function between groups exposed to BBPS and HPS. Bicarbonate-based purge solution seems a feasible and safe option for patients with contraindications to heparin use. Prospective studies are needed to confirm our findings.