Sodium Bicarbonate Infusion as an Alternative to Heparin Purge in Temporary Axial Flow Ventricular Support Devices
Kyle Simonsen, MD1, Daniel Beckles, MD, PhD1, Michael Koerner, BS2, Giuseppe Tavilla, MD, PhD1, Ramachandra Reddy, MD1.
1Baylor Scott & White Health, Temple, TX, USA, 2Texas A&M Health Science Center, Temple, TX, USA.
BACKGROUND: Temporary axial flow ventricular support devices are a life-saving treatment option in acute heart failure and may be used as a bridge to recovery, mechanical device placement, or transplantation. To prevent thrombosis, devices require a purge line that traditionally use a continuous Heparin or other anticoagulant infusion. Patients with contraindications to traditional anticoagulants require alternative anticoagulation strategies.
METHODS: Over the previous 6 months, 12 patients have received temporary axial flow ventricular support devices at our institution. Of these, 4 patients were found to have contraindications to traditional anticoagulant use and were managed with a continuous bicarbonate infusion. In these patients, a solution of 25 mEq sodium bicarbonate in 5% dextrose was titrated to maintain a purge line pressure greater than 300 mmHg.
RESULTS: Of the series of 4 patients, 3 patients were positive for HIT and 1 patient experienced a serious GI bleed. Total duration of therapy ranged from 22-46 days. Infusion rates of sodium bicarbonate ranged from 5.1-13.9 mL/hr. All patients developed a degree of systemic alkalosis (maximum pH range 7.49-7.62). 2 patients developed hypernatremia (maximum sodium range 140-156). 2 patients survived until removal, 1 patientís care was withdrawn while on temporary support, and 1 patient remains on temporary support. No pump thrombosis events were observed.
CONCLUSIONS: Use of a continuous sodium bicarbonate infusion in patients requiring temporary axial flow ventricular support devices with contraindications to traditional anticoagulants is a safe and simple alternative to prevent pump thrombosis.
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