case_images: PMC11832679_01
case_images: Trends in Impella purge flow and pressure. BBPS, bicarbonate-based purge solution; DOB, dobutamine; HIT, heparin-induced thrombocytopenia; MCS, mechanical circulatory support; MIL, milrinone; NAD, noradrenaline; VA-ECMO, veno-arterial extracorporeal membrane oxygenation
case_images: 10047_2024_1452_Fig1_HTML.jpg
case_images: PMC11832679_01_10047_2024_1452_Fig1_HTML.jpg
case_images: Fig1
case_images: Owing to worsening of the patient's hemodynamic status by infection at the catheter site on day 6, we upgraded the mechanical circulatory support (MCS) from IABP to Impella CP (Fig. 1), which was placed via the left femoral artery approach on day 6. Therefore, we changed the device to Impella 5.0 (Fig. 1), which was placed via the right femoral artery approach on day 14. Therefore, veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was added as MCS via the left femoral arteriovenous approach, along with the third Impella CP (Fig. 1) placed via the right subclavian artery approach on day 24 to maintain systemic hemodynamics.
case_images: Trends in blood lactate dehydrogenase, hemoglobin, and platelet count. BBPS, bicarbonate-based purge solution; Hb, hemoglobin; HIT, heparin-induced thrombocytopenia; LDH, lactate dehydrogenase; MCS, mechanical circulatory support; Plt, platelet; VA-ECMO, veno-arterial extracorporeal membrane oxygenation
case_images: 10047_2024_1452_Fig2_HTML.jpg
case_images: PMC11832679_01_10047_2024_1452_Fig2_HTML.jpg
case_images: Fig2
case_images: Meanwhile, the platelet count decreased steadily from 162,000/L at the time of transfer to 31,000/L on day 9, and laboratory data revealed platelet-activated anti-platelet factor 4/heparin antibody > 5.0 U/mL (normal range < 1.0 U/mL) (Fig. 2). Despite the addition of VA-ECMO to Impella CP as MCS, there was no exacerbation of hemolysis, and the patient could be managed for approximately 1 month (Fig. 2).