Intra-aortic balloon pump (IABP) counterpulsation improves cerebral perfusion in patients with decreased left ventricular function

Pfluecke, Christian; Christoph, Marian; Kolschmann, Steffen; Tarnowski, Daniel; Forkmann, Mathias; Jellinghaus, Stefanie; Poitz, DM; Wunderlich, Carsten; Strasser, R. H.; Schoen, Steffen; Ibrahim, Karim

doi:10.1177/0267659114525218

Cited by 30 publications

(23 citation statements)

References 32 publications

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“…Overall, cerebral perfusion relates to CO and blood pressure and to their distinct effects on cerebral haemodynamics [29]. Therefore, enhancement of cardiac performance and optimization of fluid balance, could improve brain perfusion especially in patients with impaired cardiac function [30,31]. Infusion of osmotic therapies -mannitol and HTS -promote a water shift from intracellular to the extracellular (and thus intravascular) compartments and direct peripheral vasodilation, ultimately leading to CO augmentation [3,32,33].…”

Section: Discussionmentioning

confidence: 99%

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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AIMOsmotherapy constitutes a first-line intervention for intracranial hypertension management. However, hyperosmolar solutes exert various systematic effects, among which their impact on systemic haemodynamics is poorly clarified. This review aims to appraise the clinical evidence of the effect of mannitol and hypertonic saline (HTS) on cardiac performance in neurosurgical and neurocritical care patients. METHODA database search was conducted to identify randomized clinical trials and observational studies reporting HTS or mannitol use in acute brain injury setting. The primary end-points were alterations of cardiac output (CO) and other haemodynamic variables, while the impact of osmotic agents on intracranial pressure, brain relaxation, plasma osmolality, electrolyte levels and urinary output constituted secondary outcomes. RESULTSEight studies, enrolling 182 patients in total, were included. HTS exerted a more profound cardiac output augmentation than mannitol, but no distinct difference between groups occurred. Central venous pressure, stroke volume and stroke volume variation were favourably affected by both osmotic agents, whilst the reported changes in blood pressure were inconclusive. HTS infusion yielded a larger intracranial pressure reduction than mannitol but had an equivalent effect on brain relaxation. Mannitol presented a more potent diuretic effect than HTS. Effect on serum osmolality was alike in both osmotic agents, but contrary to HTS-promoted hypernatraemia, mannitol use induced transient hyponatraemia. CONCLUSIONSMannitol or HTS administration seems to induce an enhancement of cardiac performance; being more prominent after HTS infusion. This effect combined with mannitol-induced enhancement of diuresis and HTS-promoted increase of plasma sodium concentration could partially explain the effects of osmotherapy on cerebral haemodynamics. British Journal of Clinical Pharmacology WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT• Osmotherapy with either mannitol or hypertonic saline (HTS) is the recommended first-line medical intervention for optimizing cerebral perfusion through brain relaxation.• Mannitol has long been used as osmotic agent for ensuring brain relaxation in neurosurgical patients undergoing craniotomy, but the clinical benefit of mannitol infusion in acute brain injury setting, has not yet been proven according to evidence-based medicine.• Recent guidelines suggest the use of HTS as a second-line therapy in case mannitol fails to reduce intracranial pressure, in patients sustaining traumatic brain injury. WHAT THIS STUDY ADDS• Both mannitol and HTS induce an increase in cardiac output, which is more pronounced after HTS than mannitol administration.• Mannitol and HTS infusion are associated with a trend towards to mean arterial pressure and heart rate reduction.• Both osmotic agents induced an intracranial pressure reduction and brain relaxation, an effect that seems to be more prominent in HTS-treated patients.

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Section: Discussionmentioning

confidence: 99%

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Tsaousi

Stazi

Cinicola

et al. 2018

Brit J Clinical Pharma

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“…Another popular condition for this form of treatment is high-risk that patients are undergoing artery bypass grafting surgery. Treatment using the IABP for patients with severe heart failure showed an increase in cerebral blood flow by 20% augmentation [18]. This increase in blood flow is thought to be an indirect result of the IABP, due to the displacement of blood volume, leading to an increase in coronary flow.…”

Section: Iabp Architecture and Indicationsmentioning

confidence: 99%

“…This increase in blood flow is thought to be an indirect result of the IABP, due to the displacement of blood volume, leading to an increase in coronary flow. For patients that suffer from ischemic stroke, a decrease in left ventricular afterload and increase in cerebral perfusion can be beneficial, which is one reason physicians use the IABP as a form of treatment [18]. Research has also shown that the pump can be used in patients who have undergone a transplant, by normalizing reduced cerebral blood flow.…”

Section: Iabp Architecture and Indicationsmentioning

confidence: 99%

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Intra-Aortic Balloon Pump for Patients with Cardiac Conditions: An Update on Available Techniques and Clinical Applications

Limbert

Amiri

2019

Reports

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In this paper, we present a review of the intra-aortic balloon pump, as well as the usage of it in the medical field today. An intra-aortic balloon pump (IABP) is a biomedical device that can assist the heart during unstable angina or after a heart attack. This pump is typically used in patients who suffer from ischemia of the heart tissue, due to an unbalanced level of myocardial oxygen supply or demand. Through counterpulsation, which is a technique to synchronize the external pumping of blood with the heart’s cycle, the device can balance the supply and demand of blood that is necessary for the heart to pump properly. The IABP is comprised of the following four components: a polyurethane balloon, a polyethylene or fiber-optic catheter, a transducer, and the intra-aortic balloon pump console. In the past, researchers have used other materials that have low biocompatibility and can cause complications within the body. This analysis will explain the complications and state changes that occurred due to them. Limitations of past designs and advantages of current designs will be acknowledged, for they can be used by researchers to enhance designs for the future. Consequently, the analysis of this device may lead to improved designs and treatment in the future for patients with cardiac conditions.

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“…Згідно з даними літератури, ВАБК покращує церебральний кровотік. Pfluecke et al у своїй статті показали, що застосування ВАБК підвищив мозковий кровотік на 20 %, при цьому найбільший ефект спостерігався у пацієнтів зі значно зниженою функцією ЛШ [7]. Це може пояснюватись як прямим впливом ВАБК, а саме зміщенням об'єму крові ретроградно під час діастоли в сонні артерії, так і опосередкованимвнаслідок підвищення серцевого викиду через покращання коронарного кровотоку.…”

Section: вступunclassified

Effect of Intraaortic Balloon Counterpulsation on the Duration of Mechanical Ventilation, Renal Function, and the Neurological Complications in Patients With Low Cardiac Output Syndrome After Cardiac Surgery

Кузьмич¹,

України»²,

Мельник³

et al. 2018

Clinical Anesthesiology and Intensive Care

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J., Brull R., Hadzic A. The second ASRA practice advisory on neurologic complications associated with regional anesthesia and pain medicine: executive summary 2015. И. М. Кузьмич, М. Г. Мельник, А. С. Маслюков, В. С. Шевченко ВЛИЯНИЕ ВНУТРИАОРТАЛЬНОЙ БАЛЛОННОЙ КОНТРПУЛЬСА-ЦИИ НА ПРОДОЛЖИТЕЛЬНОСТЬ МЕХАНИЧЕСКОЙ ВЕНТИЛЯЦИИ ЛЕГКИХ, ФУНКЦИЮ ПОЧЕК И НА КОЛИЧЕСТВО НЕВРОЛОГИЧЕ-СКИХ ОСЛОЖНЕНИЙ У ПАЦИЕНТОВ С СИНДРОМОМ НИЗКОГО СЕРДЕЧНОГО ВЫБРОСА ПОСЛЕ КАРДИОХИРУРГИЧЕСКИХ ОПЕ-РАЦИЙВнутриаортальная баллонная контрпульсация (ВАБК) -самый распространенный вид временной механической поддержки кровообращения, что позволяет улучшить сердечный выброс и коронарную перфузию, одновременно снижая напряжение на стенку левого желудочка (ЛЖ) и давление заклинивания легочных капилляров (ДЗЛК). Целью работы было оценить влияние механической поддержки кровообращения с помощью ВАБК на продолжительность искусственной вентиляции легких (ИВЛ), функцию почек и частоту возникновения энцефалопатий в раннем послеоперационном периоде. Для этого авторами было проведено ретроспективное обсервационное исследование, в котором принимали участие 58 пациентов с фракцией выброса < 40 %, которым было выполнено кардиохурургические вмешательства в условиях искусственного кровообращения в ГУ «Институт сердца МЗ Украины» за 7-месяч-

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Intra-aortic balloon pump (IABP) counterpulsation improves cerebral perfusion in patients with decreased left ventricular function

Abstract: IABP improves cerebral blood flow, particularly in patients with pre-existing heart failure and highly impaired LVEF. Hence, an IABP might be a treatment option to improve cerebral perfusion in selected patients with cerebral misperfusion and simultaneously existing severe heart failure.

Cited by 30 publications

References 32 publications

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Cardiac output changes after osmotic therapy in neurosurgical and neurocritical care patients: a systematic review of the clinical literature

Intra-Aortic Balloon Pump for Patients with Cardiac Conditions: An Update on Available Techniques and Clinical Applications

Effect of Intraaortic Balloon Counterpulsation on the Duration of Mechanical Ventilation, Renal Function, and the Neurological Complications in Patients With Low Cardiac Output Syndrome After Cardiac Surgery

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