The Acute Effect of Intra‐aortic Balloon Counterpulsation During Extracorporeal Life Support: An Experimental Study

Abstract

Hemodynamically unstable patients supported by an extracorporeal life support (ECLS) circuit often receive additional support by intra-aortic balloon pump (IABP). However, it is not established whether support of the failing heart is improved by adjunctive IABP in both peripheral cannulation (PC) and central cannulation (CC) settings. Seven sheep were supported by an IABP and an ECLS system which were cannulated centrally as well as peripherally. In each cannulation configuration, hemodynamic and cardiac function indices were measured at baseline, ECLS, and ECLS plus IABP. The primary variables were mean coronary artery flow (Qcor), diastolic pressure time index (DPTI), left ventricular (LV) pressure-volume area (PVA), and tension time index (TTI). Additional IABP with ECLS support (CC/PC) decreased LV afterload (LV systolic peak pressure -4%, P<0.05/-8%, P<0.02), as well as TTI -2%/-10% and PVA -10%/-12% (P<0.03). Coronary perfusion was increased by additional IABP: CC, Qcor, +9%, and DPTI, +18% (P<0.02); PC, Qcor,+6%, and DPTI, +11% (P<0.05). IABP augmented the myocardial oxygen supply/demand ratios (CC/PC): Qcor/(PVA.heart rate) (+21%/+22%, P<0.02) and DPTI/TTI (+27%/+24%, P<0.03). In case of low arterial pressure (<50 mm Hg) and reduced ECLS flow, the overall hemodynamic profile improved only with central cannulation. We conclude that in both central and peripheral ECLS cannulation settings, adjunctive IABP improves the myocardial oxygen supply demand balance. In case of low cardiac output and insufficient extracorporeal flow with PC, adjunctive IABP may be contraindicated.

Coronary versus carotid blood flow and coronary perfusion pressure in a pig model of prolonged cardiac arrest treated by different modes of venoarterial ECMO and intraaortic balloon counterpulsation

“…We speculate that an intermittent aortic occlusion by the IABP balloon may diminish blood flow available for the aortic root (and thus for coronary arteries), more than for the aortic arch (and thus for the carotids). These results are in accordance with a report by Sauren [34], where addition of IABP in severely hypotensive ECMO-treated animals was not beneficial; however, the animals were not in cardiac arrest. On the other hand, the subclavian approach seems to be suitable for IABP assistance because the outflow cannula is located proximal to the IABP balloon.…”

Role of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation in Early Graft Failure After Cardiac Transplantation

“…Multidisciplinary monitoring and management may well be the key to success . A principal goal during ECMO should be to ensure that the aortic valve opens and that some blood flows through the chambers, particularly when the left ventricular function is severely compromised; this may be achieved by IV infusion of a moderate dose of inotropes and use of IABP . Additionally, strict peripheral vascular perfusion Doppler monitoring should be performed to avoid deleterious leg complications .…”

Clinical impact of intra-aortic balloon pump during extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock

“…An experimental study suggested that IABP-induced pulsatility improves coronary bypass graft flows during nonpulsatile ECLS [11]. Another study proposed that adjunctive IABP improves the myocardial oxygen supply–demand balance in peripheral extracorporeal life support [12]. These benefits of IABP might increase coronary flow during diastole and compensate for limitations of ECLS, such as myocardial oxygen consumption associated with increased LV afterload.…”