Concomitant Intra-Aortic Balloon Pumping Significantly Reduces Left Ventricular Pressure during Central Veno-Arterial Extracorporeal Membrane Oxygenation—Results from a Large Animal Model

Abstract

(1) Introduction: Simultaneous ECMO and IABP therapy is frequently used. Haemodynamic changes responsible for the success of the concomitant mechanical circulatory support system approach are rarely investigated. In a large-animal model, we analysed haemodynamic parameters before and during ECMO therapy, comparing central and peripheral ECMO circulation with and without simultaneous IABP support. (2) Methods: Thirty-three female pigs were divided into five groups: (1) SHAM, (2) (peripheral)ECMO(–)IABP, (3) (p)ECMO(+)IABP, (4) (central)ECMO(–)IABP, and (5) (c)ECMO(+)IABP. Pigs were cannulated in accordance with the group and supported with ECMO (±IABP) for 10 h. Systemic haemodynamics, cardiac index (CI), and coronary and carotid artery blood flow were determined before, directly after, and at five and ten hours on extracorporeal support. Systemic inflammation (IL-6; IL-10; TNFα; IFNγ), immune response (NETs; cf-DNA), and endothelial injury (ET-1) were also measured. (3) Results: IABP support during antegrade ECMO circulation led to a significant reduction of left ventricular pressure in comparison to retrograde flow in (p)ECMO(–)IABP and (p)ECMO(+)IABP. Blood flow in the left anterior coronary and carotid artery was not affected by extracorporeal circulation. (4) Conclusions: Concomitant central ECMO and IABP therapy leads to significant reduction of intracavitary cardiac pressure, reduces cardiac work, and might therefore contribute to improved recovery in ECMO patients.

Fluid Management in Veno-Arterial Extracorporeal Membrane Oxygenation Therapy—Analysis of an Experimental Pig Model

“…The study performed is a retrospective, not pre-planned, subanalysis of one particular study arm, which was part of a large animal experimental protocol investigating concomitant extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) and was approved by the responsible ethical committee for animal care of the University of Cologne (LANUV, Bonn, Northrhine-Westphalia, Germany) [ 22 ]. Data were prospectively collected.…”

Endothelial and Hemodynamic Function in a Large Animal Model in Relation to Different Extracorporeal Membrane Oxygenation Cannulation Strategies and Intra-Aortic Balloon Pumping

“…Funding was supported by the Koeln Fortune Programm (343/2015), Faculty of Medicine, University of Cologne. All relevant procedures (experimental protocol and subsequent analysis) were performed between May 2017 and December 2021 at the institution of the Experimental Medicine of the Faculty of Medicine and University Hospital Cologne and the laboratories of the Department of Cardiothoracic Surgery of the University Hospital Cologne [ 10 ].…”

“…Enzyme-linked immunosorbent assays were performed in accordance with manufacturers’ recommendations (ET-1, R&D Systems Inc., Minneapolis, MN, USA; MPO, USCN Life Science Inc., Wuhan, China). Further analysis of blood samples, including creatine kinase (CK), creatine kinase muscle–brain (CK-MB), troponin and creatinine, was conducted in the central laboratory of the university hospital (University Hospital Cologne, Cologne, Germany) as previously described by our research group in “ Concomitant Intra-Aortic Balloon Pumping Significantly Reduces Left Ventricular Pressure during Central Veno-Arterial Extracorporeal Membrane Oxygenation—Results from a Large Animal Model ” [ 10 ].…”

“…Stable precontraction was then induced by prostaglandin F2 a (10 μmol/L) and endothelium-dependent relaxation to bradykinin was recorded by adding accumulating concentrations (0.0001–10 μmol/L). The mean vessels endothelial function was determined by calculating the average percentage change of vasorelaxation following bradykinin administration [ 10 ].…”

Clinical Application of Extracorporeal Membrane Oxygenation in the Treatment of Fulminant Myocarditis

“…Djordjevic et al . [ 98 ] showed that central ECMO blood flow is associated with better left ventricular decompression, suggesting that central ECMO may have some left heart decompression effect. However, another study [ 99 ] indicates that either peripheral or central cannulation negatively affects left ventricular contraction, and both can lead to some degree of left ventricular distension.…”