Mechanical Intraaortic Cardiac Assistance in Cardiogenic Shock

Kantrowitz, Ádrian; Tjønneland, Steinar; Krakauer, Joseph S.; Phillips, Steven J.; Freed, Paul S.; Butner, Alfred N.

doi:10.1001/archsurg.1968.01340060178021

Cited by 68 publications

(13 citation statements)

References 6 publications

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“…Williamson, for example, using the ratio of beta hydroxybutyrate to acetoacetate has shown that the hepatic mitochondrion is 100 times more reduced than the cytoplasm suggesting that changes in the cytoplasmic NADH/NAD ratio are at best a damped representation of intramitochondrial events (76). An (18) and animal data from the microembolization studies of Bing and associates (40). Patients with shock from other causes or with low cardiac output tend to cluster in quadrant I and II which represent lactate and pyruvate extraction or lactate extraction and pyruvate production, respectively.…”

Section: Critique Of Experimental Methodsmentioning

confidence: 99%

“…Five patients survived for more than 1 wk and one patient was discharged from the hospital. Patients 3-7 and 16-18 were treated with phaseshift balloon pumping (18). Postmortem examinations were performed in 9 of the 17 patients who died and revealed extensive old and recent myocardial infarction associated with severe coronary artery disease.…”

Section: Clinical Course and Pathologic Findingsmentioning

confidence: 99%

“…Iso-proterenol (2,7,(10)(11)(12), l-norepinephrine (3,5,6,8,(12)(13)(14), alpha adrenergic blocking agents (11,12,15), intra-aortic phase-shift balloon pumping (16)(17)(18)(19), and other techniques have been recommended for coronary shock but evidence of their efficacy has been limited to measurements of cardiac output and peripheral vascular resistance.…”

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confidence: 99%

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Hemodynamics, coronary blood flow, and myocardial metabolism in coronary shock; response to l-norepinephrine and isoproterenol

Mueller¹,

Ayres²,

Gregory³

et al. 1970

J. Clin. Invest.

113

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Section: Critique Of Experimental Methodsmentioning

confidence: 99%

Section: Clinical Course and Pathologic Findingsmentioning

confidence: 99%

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Hemodynamics, coronary blood flow, and myocardial metabolism in coronary shock; response to l-norepinephrine and isoproterenol

Mueller¹,

Ayres²,

Gregory³

et al. 1970

J. Clin. Invest.

113

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show abstract

“…distal to the left subclavian artery. The position of the balloon was determined by fluoroscopy with a portable image intensifier2 before the catheter was secured in the artery using the method described by Kantrowitz et al (18). Balloons of either 33 or 27 ml were used depending upon the size of the patient.…”

Section: Experimental Protocolmentioning

confidence: 99%

“…Recent studies have suggested that intra-aortic counterpulsation (IACP) may decrease ventricular work and increase oxygen delivery in coronary shock (10,(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29). Detailed studies of myocardial metabolism with IACP have not been reported, however.…”

mentioning

confidence: 99%

The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction

Mueller¹,

Ayres²,

Conklin³

et al. 1971

J. Clin. Invest.

145

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A B S T R A C T The effect of intra-aortic counterpulsation (IACP, 22-94 hr) on hemodynamics and cardiac energetics was evaluated in 10 patients in shock after acute myocardial infarction. The data clearly indicate that IACP improves myocardial oxygenation, enhances peripheral perfusion, and probably improves myocardial contractility in the severely diseased heart.Before treatment, decreases in cardiac index (mean value, 1.22 liter/min per m'), systolic ejection rate (67 ml/sec), and time-tension index per minute (1280 mm Hg -sec/min) were observed. Systemic vascular resistance varied widely. Low coronary blood flow (68 ml/min per 100 g) was associated with increased myocardial oxygen extraction (79%), low coronary sinus oxygen tension (20 mm Hg), and abnormal myocardial lactate-pyruvate metabolism.During 4-6 hr of IACP, systolic pressure and left ventricular outflow resistance decreased by 18% and 24%, respectively, while cardiac index improved by 38%. Diastolic arterial pressure rose 98%. Increase in coronary blood flow from an average of 68 to 91 ml/100 g per min (P < 0.001) was significantly correlated with rise in mean arterial pressure (r = 0.685). This correlation was best expressed in a third-order curve, which intercepts the point of no flow at a mean aortic pressure of 30 mm Hg. The flow-pressure curve is relatively flat above 65-70 mm Hg, but becomes steeper as mean aortic pressure falls below this point. Myocardial oxygen consumption remained essentially unchanged during early IACP and tended to rise during the later stages.However, the relationship of cardiac work performed to oxygen availability was markedly improved. Myocardial

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