Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation

Bréchot, Nicolas; Demondion, Pierre; Santi, Francesca De; Lebreton, Guillaume; Pham, Tài; Dalakidis, Apostolos; Gambotti, Laëtitia; Luyt, Charles‐Édouard; Schmidt, Matthieu; Hékimian, Guillaume; Cluzel, Philippe; Chastre, Jean; Leprince, Pascal; Combes, Alain

doi:10.1177/2048872617711169

Cited by 132 publications

(86 citation statements)

References 41 publications

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“…As ECMO increases afterload of LV and reduces coronary artery blood flow, combining with IABP could make up for the shortages of ECMO support. Previous studies showed that additional application of IABP reduced pulmonary artery occlusion pressure and hydrostatic pulmonary edema, and increased cerebral blood flow in patients with ECMO . However, it is still controversial whether combining application of IABP improves survival of patients with ECMO support.…”

Section: Discussionmentioning

confidence: 99%

“…An intra‐aortic balloon pump (IABP) could reduce LV afterload and increase coronary artery blood flow through inflating during diastole and deflating during systole. In addition, IABP implantation showed reduced pulmonary artery occlusion pressure and hydrostatic pulmonary edema, and increased cerebral blood flow in patients with ECMO . Combined use of IABP with ECMO is common in PCS, with a rate of 25 to 74% in various centers .…”

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confidence: 99%

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Concurrent Implantation of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock

et al. 2018

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The aim of this study is to report the combined application of extracorporeal membrane oxygenation (ECMO) with intra‐aortic balloon pumping (IABP) in postcardiotomy cardiac shock (PCS). A total of 60 consecutive patients who received both ECMO and IABP (concomitantly 24 hours) for PCS from February 2006 to March 2017 at Fuwai Hospital were included in our study. Clinical characteristics of the patients were collected retrospectively and compared between survivors and non‐survivors. Logistic regression analysis was used as predictors for survival to discharge. The study cohort had a mean age of 51.4±12.7 years with 75% males. ECMO was implanted intra‐operatively in 38 (63%) patients and post‐operatively in 22 (37%) patients. ECMO was implanted concurrently with IABP in 38 (63%) patients. Heart transplantation (38%) and coronary artery bypass graft (33%) were the main surgical procedures. ECMO was weaned successfully in 48% patients, and the rate of survival to discharge was 43%. Survivors showed less bedside ECMO implantation (12% vs. 41%, P=0.012) and more concurrent implantation of ECMO with IABP (81% vs. 50%, P=0.014). Concurrent implantation of IABP with ECMO (OR=0.177, P=0.015, 95% CI: 0.044‐0.718) was an independent predictor of survival to discharge. As for complications, the rate of renal failure (59% vs. 15%, P=0.001) and multiple organ dysfunction syndrome (29% vs. 0, P=0.003) was higher in patients who failed to survive to discharge. Patients who had heart transplantation had a better long‐term survival than others (P=0.0358). In summary, concurrent implantation of ECMO with IABP provides better short‐term outcome for PCS and combined application of ECMO with IABP for PCS after heart transplantation had a favorable long‐term outcome.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Concurrent Implantation of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock

et al. 2018

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“…IABP is frequently used in cardiogenic shock to improve diastolic coronary perfusion, as well as reduce left ventricular afterload and pulmonary edema. When used together with VA-ECMO it may improve coronary and cerebral perfusion, [68][69][70][71] facilitate left ventricular unloading and weaning from VA-ECMO, 72 reduce hospital mortality, 73 and reduce the risk of pulmonary edema 74 .…”

Section: Iabpmentioning

confidence: 99%

“…Brechot et al 74 conducted a retrospective single center study of 259 patients requiring VA-ECMO support, of whom 104 also received IABP support. Chest X-rays were assessed, and pulmonary edema was graded according to the Weinberg radiologic score.…”

Section: Iabpmentioning

confidence: 99%

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

Desai

Hwang

2020

Journal of Cardiothoracic and Vascular Anesthesia

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“…La experiencia por el momento es baja, el coste con respecto a la ECMO es mayor, pueden no aportar el suficiente soporte hemodinámico en los pacientes más graves (12), y son difíciles de implementar en los programas de transporte primario. En cuanto al BIAC ya no se recomienda de forma rutinaria en el shock cardiogénico (18), aunque sí hay estudios que apoyan su uso concomitante a la ECMO VA al mejorar la hemodinámica y disminuir el riesgo de EAP (40,41). No existen estudios prospectivos exclusivamente de transporte de pacientes con shock cardiogénico.…”

Section: Criterios De Ecmo Para Traslado En El Shock Cardiogénicounclassified

Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation

Burgueño

González

Sarralde

et al. 2019

Medicina Intensiva (English Edition)

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Extracorporeal membrane oxygenation (ECMO) support is indicated for patients who are refractory to treatment, those with cardiogenic shock or respiratory failure and those with exacerbations eligible for heart and lung transplantation. The practitioner's experience and quantity of necessary resources are reasons why regionalization could benefit these types of patients, establishing ECMO reference centers and integrating a transportation network specialized in ECMO. This type of transportation is a challenge for healthcare systems and physicians, given its greater complexity, requiring a multidisciplinary and interterritorial approach. ECMO transportation is safer than without mechanical support, although there are currently no criteria for starting the therapy on patients being transferred. Criteria of lesser severity might be necessary for these patients. The training and specialization of the team in extracorporeal support therapies, interfacility transport and the systemization of the transfer can improve results. There are no studies on the conditions that must be met by the transportation media, although space and stability are important characteristics. Air transfer with ECMO is an increasingly frequent option. Although there are data on its safety, there are none on the physiology of patients undergoing ECMO at high altitudes, data that could help with the indication and management of this type of transportation.

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Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation

Abstract: Associating an IABP with peripheral VA-ECMO was independently associated with a lower frequency of hydrostatic pulmonary oedema and more days off mechanical ventilation under ECMO.

Cited by 132 publications

References 41 publications

Concurrent Implantation of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock

Concurrent Implantation of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

Issues to resolve with the use of extracorporeal membrane oxygenation during interfacility transportation

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