Purpose: The extended use of an Impella LP 2.5 percutaneous left-ventricular assist device (pVAD) without a heparin-based purge solution in a patient who developed cardiogenic shock after acute myocardial infarction (AMI) is described.
Summary: 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.
Conclusion: An Impella LP 2.5 pVAD was used for 75 hours with a purge solution that contained no heparin. There were no thrombotic or bleeding complications.