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Critical Care Medicine:
doi: 10.1097/CCM.0000000000000410
Clinical Investigations

Intra-Aortic Balloon Pump Effects on Macrocirculation and Microcirculation in Cardiogenic Shock Patients Supported by Venoarterial Extracorporeal Membrane Oxygenation*

Petroni, Thibaut MD1; Harrois, Anatole MD, PhD2; Amour, Julien MD, PhD3; Lebreton, Guillaume MD4; Brechot, Nicolas MD, PhD1; Tanaka, Sébastien MD2; Luyt, Charles-Edouard MD, PhD1; Trouillet, Jean-Louis MD1; Chastre, Jean MD1; Leprince, Pascal MD, PhD4; Duranteau, Jacques MD, PhD2; Combes, Alain MD, PhD1

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Abstract

Objectives: This study was designed to assess the effects on macrocirculation and microcirculation of adding an intra-aortic balloon pump to peripheral venoarterial extracorporeal membrane oxygenation in patients with severe cardiogenic shock and little/no residual left ventricular ejection.

Design: A prospective, single-center, observational study where macrocirculation and microcirculation were assessed with clinical-, Doppler echocardiography–, and pulmonary artery–derived hemodynamic variables and also cerebral and thenar eminence tissue oxygenation and side-stream dark-field imaging of sublingual microcirculation.

Setting: A 26-bed tertiary ICU in a university hospital.

Patients: We evaluated 12 consecutive patients before and 30 minutes after interrupting and restarting intra-aortic balloon pump.

Interventions: Measurements were performed before, and 30 minutes after interrupting and restarting intra-aortic balloon pump.

Measurements and Main Results: Stopping intra-aortic balloon pump was associated with higher pulmonary artery-occlusion pressure (19 ± 10 vs 15 ± 8 mm Hg, p = 0.01), increased left ventricular end-systolic (51 ± 13 vs 50 ± 14 mm, p = 0.05) and end-diastolic (55 ± 13 vs 52 ± 14 mm, p = 0.003) dimensions, and decreased pulse pressure (15 ± 13 vs 29 ± 22 mm Hg, p = 0.02). Maximum pulmonary artery-occlusion pressure reduction when the intra-aortic balloon pump was restarted was observed in the seven patients whose pulmonary artery-occlusion pressure was more than 15 mm Hg when intra-aortic balloon pump was off (–6.6 ± 4.3 vs –0.6 ± 3.4 mm Hg, respectively). Thenar eminence and brain tissue oxygenation and side-stream dark-field–assessed sublingual microcirculation were unchanged by stopping and restarting intra-aortic balloon pump.

Conclusions: Restoring pulsatility and decreasing left ventricular afterload with intra-aortic balloon pump was associated with smaller left ventricular dimensions and lower pulmonary artery pressures but did not affect microcirculation variables in cardiogenic shock patients with little/no residual left ventricular ejection while on peripheral venoarterial extracorporeal membrane oxygenation.

© 2014 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins

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