Cerebral hemodynamics with intra-aortic balloon pump: business as usual?

Abstract

IABP does not disturb cerebral hemodynamics. TFA and continuous estimates of dynamic CA can be used to assess cerebral hemodynamics in patients with IABP. These findings have important implications for the design of studies of critically ill patients requiring the use of different invasive support devices.

Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial

“…2, showing the altered cardiac cycle patterns resulting from inflation and deflation of the IABP with a 1:3 ratio.

Fig. 2Ten-second continuous recording of blood pressure and cerebral blood flow velocity from 63-year-old male patient with IABP ratio 1:3, showing removal of the intra-aortic balloon pump at t = 6 s. This subject is representative of the frequent occurrence of cerebral blood flow velocity diastolic values that are negative or near zero following deflation of the balloon(Reproduced with permission from Caldas et al [22])

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“…In assessing the effects of IABP on BP and CBFV, we expressed diastolic values at their usual point of occurrence that is the end of diastole. In doing so, we followed the literature and also highlighted the most relevant hemodynamic changes induced by the cycling of balloon inflation/deflation [22] resulting in the differences shown in Table 3. On the other hand, this choice does not reflect the potential benefits of IABP to improve coronary artery perfusion that are likely to be better expressed by averaged values over the entire duration of diastole.…”

“…Dynamic cerebral autoregulation (CA) was assessed using transfer function analysis, using spontaneous fluctuations of MAP as input and corresponding changes in CBFVm as output in recordings lasting 5 min, as described previously [21, 22]. The Welch method was adopted for smoothing spectral estimates obtained with the fast Fourier transform (102.4 s segments, 50% superposition) leading to frequency-dependent estimates of coherence, gain and phase.…”

Intra-Aortic Balloon Pump (IABP) in ICU: Cerebral Hemodynamics Monitoring by Transcranial Doppler (TCD/TCCS)

“…Hitherto, only two studies evaluated cerebral autoregulation in patients with IABP [37,38]. These studies used different methods to assess cerebral autoregulation.…”

“…These studies used different methods to assess cerebral autoregulation. Caldas et al (2017) used transfer function analysis and the autoregulation index (ARI) to quantify the efficiency of CA [31,37]. The second study (Bellapart 2010) was based on the time-delay between fluctuations in CBFV and ABP, estimated using a cross-correlation technique.…”