Effects of intra-aortic balloon pump on cerebral blood flow during peripheral venoarterial extracorporeal membrane oxygenation support

Journal of Translational Medicine

Xiao-tong Hou²  Ming Jia¹  Hong Wang¹  Chun-jing Jiang²  Xing Hao²  Yuan Liu²  Zheng Wang²  Jia-lin Xing²  Zai-shen Jia²  Feng Yang² 

[1] Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, China;Department of Extracorporeal Circulation, Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Rd, Chaoyang District, Beijing 100029, P.R. China

关键词: Transcranial doppler ultrasound;    Cerebral blood flow;    Venoarterial extracorporeal membrane oxygenation;    Intra-aortic balloon pump;   

Others  :  814914
DOI  :  10.1186/1479-5876-12-106

 received in 2013-12-05, accepted in 2014-04-14,  发布年份 2014

【 摘 要 】

Background

The addition of an intra-aortic balloon pump (IABP) during peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) support has been shown to improve coronary bypass graft flows and cardiac function in refractory cardiogenic shock after cardiac surgery. The purpose of this study was to evaluate the impact of additional IABP support on the cerebral blood flow (CBF) in patients with peripheral VA ECMO following cardiac procedures.

Methods

Twelve patients (mean age 60.40 ± 9.80 years) received VA ECMO combined with IABP support for postcardiotomy cardiogenic shock after coronary artery bypass grafting. The mean CBF in the bilateral middle cerebral arteries was measured with and without IABP counterpulsation by transcranial Doppler. The patients provided their control values. The mean CBF data were divided into two groups (pulsatile pressure greater than 10 mmHg, P group; pulsatile pressure less than 10 mmHg, N group) based on whether the patients experienced cardiac stun. The mean cerebral blood flow in VA ECMO (IABP turned off) alone and VA ECMO with IABP support were compared using the paired t test.

Results

All of the patients were successfully weaned from VA ECMO, and eight patients survived to discharge. The addition of IABP to VA ECMO did not change the mean CBF (251.47 ± 79.28 ml/min vs. 251.30 ± 79.47 ml/min, P = 0.96). The mean CBF was higher in VA ECMO alone than in VA ECMO combined with IABP support in the N group (257.68 ± 97.21 ml/min vs. 239.47 ± 95.60, P = 0.00). The addition of IABP to VA ECMO support increased the mean CBF values significantly compared with VA ECMO alone (261.68 ± 82.45 ml/min vs. 244.43 ± 45.85 ml/min, P = 0.00) in the P group.

Conclusion

These results demonstrate that an IABP significantly changes the CBF during peripheral VA ECMO, depending on the antegrade blood flow by spontaneous cardiac function. The addition of an IABP to VA ECMO support decreased the CBF during cardiac stun, and it increased CBF without cardiac stun.

【 授权许可】

   
2014 Yang et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

【 参考文献 】

• [1]Odonkor PN, Stansbury L, Garcia JP, Rock P, Deshpande SP, Grigore AM: Perioperative management of adult surgical patients on extracorporeal membrane oxygenation support. J Cardiothorac Vasc Anesth 2013, 2:329-344.
• [2]Chen YS, Lin JW, Yu HY, Ko WJ, Jerng JS, Chang WT, Chen WJ, Huang SC, Chi NH, Wang CH, Chen LC, Tsai PR, Wang SS, Hwang JJ, Lin FY: Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 2008, 16:554-561.
• [3]Wang J, Han J, Jia Y, Zeng W, Shi J, Hou X, Meng X: Early and intermediate results of rescue extracorporeal membrane oxygenation in adult cardiogenic shock. Ann Thorac Surg 2009, 88:1897-1903.
• [4]Kagawa E, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, Kurisu S, Nakama Y, Dai K, Takayuki O, Ikenaqa H, Morimoto Y, Ejiri K, Oda N: Assessment of outcomes and differences between in- and out-of-hospital cardiac arrest treated with cardiopulmonary resuscitation with extracorporeal life support. Resuscitation 2010, 81:968-973.
• [5]Kane DA, Thiagarajan RR, Wypij D, Scheurer MA, Fynn-Thompson F, Emani S, del Nido PJ, Betit P, Laussen PC: Rapid-response extracorporeal membrane oxygenation to support cardiopulmonary resuscitation in children with cardiac disease. Circulation 2010, 122:S241-S248.
• [6]Pokersnik JA, Buda T, Bashour CA, Gonzalez-Stawinski GV: Have changes in ECMO technology impacted outcomes in adults patients developing postcardiotomy cardiogenic shock? J Card Surg 2012, 27:246-252.
• [7]O’Brien NF, Hall MW: Extracorporeal membrane oxygenation and cerebral blood flow velocity in children. Pediatr Crit Care Med 2013, 14:e126-e134.
• [8]Risnes I, Wagner K, Nome T, Sundet K, Jensen J, Hynås IA, Ueland T, Pedersen T, Svennevig JL: Cerebral outcome in adult patients treated with extracorporeal membrane oxygenation. Ann Thorac Surg 2006, 81:1401-1406.
• [9]Schachtrupp A, Wrigge H, Busch T, Buhre W, Weyland A: Influence of intra-aortic balloon pumping on cerebral blood flow pattern in patients after cardiac surgery. Eur J Anaesthesiol 2005, 22:165-170.
• [10]Madershahian N, Wippermann J, Liakopoulos O, Wittwer T, Kuhn E, Er F, Hoppe U, Wahlers T: The acute effect of IABP-induced pulsatility on coronary vascular resistance and graft flow in critical ill patients during ECMO. J Cardiovasc Surg (Torino) 2011, 52:411-418.
• [11]Madershahian N, Liakopoulos OJ, Wippermann J, Salehi-Gilani S, Wittwer T, Choi YH, Naraghi H, Wahlers T: The impact of intraaortic balloon counterpulsation on bypass graft flow in patients with peripheral ECMO. J Card Surg 2009, 24:265-268.
• [12]Doll N, Kiaii B, Borger M, Bucerius J, Krämer K, Schmitt DV, Walther T, Mohr FW: Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg 2004, 77:151-157.
• [13]Marasco SF, Vale M, Pellegrino V, Preovolos A, Leet A, Kras A, Schulberg E, Bergin P, Esmore DS: Extracorporeal membrane oxygenation in primary graft failure after heart transplantation. Ann Thorac Surg 2010, 90:1541-1546.
• [14]Polito A, Ricci Z, Di Chiara L, Iacoella C, Sanders SP, Picardo S: Cerebral blood flow during cardiopulmonary bypass in pediatric cardiac surgery: the role of transcranial Doppler-a systemic review of the literature. Cardiovasc Ultrasound 2006, 4:47. BioMed Central Full Text
• [15]Kirkham FJ, Padayachee TS, Parsons S, Searqeant LS, House FR, Gosling RG: Transcranial measurement of blood velocities in the basal cerebral arteries using pulsed Doppler ultrasound: velocity as an index of flow. Ultrasound Med Biol 1986, 12:15-21.
• [16]Mateen FJ, Muralidharan R, Shinohara RT, Parisi JE, Schears GJ, Wijdicks EF: Neurological injury in adults treated with extracorporeal membrane oxygenation. Arch Neurol 2011, 68:1543-1549.
• [17]Lan C, Tsai PR, Chen YS, Ko WJ: Prognostic factors for adult patients receiving extracorporeal membrane oxygenation as mechanical support: a 14-year experience at a medical center. Artif Organs 2010, 34:E59-E64.
• [18]Bhayana JN, Scott SM, Sethi GK, Takaro T: Effects of intraaortic balloon pumping on organ perfusion in cardiogenic shock. J Surg Res 1979, 26:108-113.
• [19]Gee W, Smith RL, Perline RK, Gallagher HS: Assessment of intra-aortic balloon pumping by ocular pneumoplethysmography. Am Surg 1986, 52:489-491.
• [20]Bělohlávek J, Mlček M, Huptych M, Svoboda T, Havránek S, Ošt'ádal P, Bouček T, Kovárník T, Mlejnský F, Mrázek V, Bělohlávek M, Aschermann M, Linhart A, Kittnar O: Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different models of venoarterial ECMO and intraaortic balloon counterpulsation. Crit Care 2012, 16:R50. BioMed Central Full Text
• [21]Applebaum RM, Wun HH, Katz ES, Tunick PA, Kronzon I: Effects of intraaortic balloon counterpulsation on carotid artery blood flow. Am Heart J 1998, 135:850-854.
• [22]Taylor GA, Martin GR, Short BL: Cardiac determinants of cerebral blood flow during extracorporeal membrane oxygenation. Invest Radiol 1989, 24:511-516.
• [23]Rosenberg AA, Kinsella JP: Effect of extracorporeal membrane oxygenation on cerebral hemodynamics in newborn lambs. Crit Care Med 1992, 20:1575-1581.
• [24]Hirschl BB, Heiss KF, Bartlett RH: Severe myocardial dysfunction during extracorporeal membrane oxygenation. J Pediatric Surg 1992, 27:48-53.