Effect of intra-aortic balloon pump support on microcirculation during high-risk percutaneous intervention

Jung, Christian; Lauten, Alexander; Rödiger, Christoph; Krizanic, Florian; Figulla, Hans R.; Ferrari, Markus

doi:10.1177/0267659109358208

Cited by 18 publications

(8 citation statements)

References 24 publications

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“…Using SDF imaging, den Uil et al documented the positive effect of intravenous low‐dose nitroglycerin infusion on tissue perfusion in acute heart failure. In addition, Jung et al observed improved perfusion of the sublingual microvasculature in patients with CS during intra‐aortic counterpulsation. Bedside evaluation of the sublingual microvasculature using SDF‐imaging is considered representative for microflow in other tissues, offering a potentially powerful tool for clinicians to target therapy …”

Section: Discussionmentioning

confidence: 99%

Microvascular tissue perfusion is impaired in acutely decompensated heart failure and improves following standard treatment

Lauten

Ferrari

Goebel

et al. 2011

European Journal of Heart Failure

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In patients with ADHF, microvascular tissue perfusion is impaired even when global haemodynamic or laboratory signs of hypoperfusion are absent. Effective pharmacological treatment to decrease neurohumoral activation significantly improves microflow. Hypoperfusion in ADHF is potentially linked to neurohumoral activation with increased plasma levels of vasoconstrictors and sympatho-adrenergic activity.

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Section: Discussionmentioning

confidence: 99%

Microvascular tissue perfusion is impaired in acutely decompensated heart failure and improves following standard treatment

Lauten

Ferrari

Goebel

et al. 2011

European Journal of Heart Failure

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“…Three recent studies examined the effects of IABP on human microcirculation [15-17]. Jung et al included 13 patients with cardiogenic shock after acute myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

“…MFI of both small and large vessels decreased significantly immediately after a short period of IABP-support discontinuation and returned to baseline after restarting therapy. Again, no correlation with global hemodynamic parameters was found [17]. …”

Section: Discussionmentioning

confidence: 99%

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Withdrawing intra-aortic balloon pump support paradoxically improves microvascular flow

et al. 2010

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IntroductionThe Intra-Aortic Balloon Pump (IABP) is frequently used to mechanically support the heart. There is evidence that IABP improves microvascular flow during cardiogenic shock but its influence on the human microcirculation in patients deemed ready for discontinuing IABP support has not yet been studied. Therefore we used sidestream dark field imaging (SDF) to test our hypothesis that human microcirculation remains unaltered with or without IABP support in patients clinically ready for discontinuation of mechanical support.MethodsWe studied 15 ICU patients on IABP therapy. Measurements were performed after the clinical decision was made to remove the balloon catheter. We recorded global hemodynamic parameters and performed venous oximetry during maximal IABP support (1:1) and 10 minutes after temporarily stopping the IABP therapy. At both time points, we also recorded video clips of the sublingual microcirculation. From these we determined indices of microvascular perfusion including perfused vessel density (PVD) and microvascular flow index (MFI).ResultsCeasing IABP support lowered mean arterial pressure (74 ± 8 to 71 ± 10 mmHg; P = 0.048) and increased diastolic pressure (43 ± 10 to 53 ± 9 mmHg; P = 0.0002). However, at the level of the microcirculation we found an increase of PVD of small vessels <20 μm (5.47 ± 1.76 to 6.63 ± 1.90; P = 0.0039). PVD for vessels >20 μm and MFI for both small and large vessels were unaltered. During the procedure global oxygenation parameters (ScvO2/SvO2) remained unchanged.ConclusionsIn patients deemed ready for discontinuing IABP support according to current practice, SDF imaging showed an increase of microcirculatory flow of small vessels after ceasing IABP therapy. This observation may indicate that IABP impairs microvascular perfusion in recovered patients, although this warrants confirmation.

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“…[7]. Darüber hinaus wurde auch die Anwendung von mechanischen "assist devices" evaluiert [24,25]. Beispielsweise wurde gezeigt, dass sich durch die Stabilisierung des Kreislaufs mithilfe extrakorporaler Membranoxygenierung (ECMO) auch die Mikrozirkulation stabilisieren lässt [16,23].…”

Section: Assessment Of Microcirculation In Critically Ill Patients Abunclassified

Beurteilung der Mikrozirkulation beim kritisch kranken Patienten

Jung

Kelm

Ferrari

2016

Med Klin Intensivmed Notfmed

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Adequate organ supply of oxygen and of nutrients depends on microcirculation. Impaired microcirculation may result in temporary or irreversible loss of function. Therefore, critically ill patients require early diagnosis and therapy of microcirculatory disorders. Besides surrogate parameters of microcirculation like urine production or serum lactate levels, direct visualization became possible with sidestream darkfield intravital microscopy. This technique has been evaluated in clinical studies focusing on early diagnosis and therapy in cardiogenic shock like vasopressors, nitrates, or circulatory assist devices. Further studies evaluating measurements of microcirculation are necessary before a general recommendation for its routine use can be made.

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Effect of intra-aortic balloon pump support on microcirculation during high-risk percutaneous intervention

Cited by 18 publications

References 24 publications

Microvascular tissue perfusion is impaired in acutely decompensated heart failure and improves following standard treatment

Microvascular tissue perfusion is impaired in acutely decompensated heart failure and improves following standard treatment

Withdrawing intra-aortic balloon pump support paradoxically improves microvascular flow

Beurteilung der Mikrozirkulation beim kritisch kranken Patienten

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