PMC9883732_01
Left panel: Chest X-ray on day 16, showing a unilateral pleural effusion on the right side (black arrow), for which a diagnostic pleural punction was performed to exclude empyema. The Impella -device is shown by the white arrow. Right panel: Chest X-ray on day 17 after pleural drainage and insertion of a pig tail catheter (black arrow), which resulted in full drainage of the pleural effusion.
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Chest X-ray showed new bilateral infiltrates and transthoracic echocardiography revealed a strongly reduced left ventricular output (LVOT-VTI 6 cm (see Supplementary Figure S1); EF 20%) where LVEF prior to the start of the oncological treatment was reported normal (see Supplementary video S1 and S2). One night after the procedure and after peripheral UFH was restarted, the patient developed a haemothorax with a significant drop in haemoglobin (BARC 3 bleeding) and a prominent expansion of the right-sided pleural effusion on chest X-ray (Figure 1A) plus escalation of vasopressor doses. After evacuation of two liters of haemorrhagic fluid, the bleeding stopped over the next few hours and the chest X-ray could not show any residual pleural effusion after drainage (Figure 1B).
Upper panel: purge pressures (mean +- standard deviation) and evolution of pfHb (measurement once daily). Lower panel: Impella  console indicating purge pressures within normal range (300-1000 mmHg) during support with BBPS.
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During the use of the BBPS (48 hours in total), there were no signs of pump thrombosis nor rising purge pressures or signs of haemolysis (Figure 2) and pH and natremia stayed within their normal range.