How should I wean my next intra-aortic balloon pump? Differences between progressive volume weaning and rate weaning

Santini, Francesco; Amoncelli, Enrico; Campanella, F; Chiominto, B.; Faggian, Giuseppe; Mazzucco, Alessandro

doi:10.1016/j.jtcvs.2012.03.063

Cited by 22 publications

(15 citation statements)

References 23 publications

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“…Onorati and colleagues [4] recently published an excellent study about this topic in patients with low CO. Similarly to their findings, we found a much better hemodynamic profile in animals weaned by progressive volume deflation compared with those weaned by a reduction in the assist rate, as demonstrated by the greater degree of vasodilation, the better CO and stroke volume, the fewer negative values of CCE, the higher dP/dT max , and the lower serum lactate leakage.…”

Section: Commentmentioning

confidence: 99%

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The Optimal Weaning Strategy for Intraaortic Balloon Counterpulsation: Volume-Based Versus Rate-Based Approach in an Animal Model

Gelsomino

Lozekoot

Lorusso

et al. 2016

The Annals of Thoracic Surgery

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Section: Commentmentioning

confidence: 99%

“…Scant data exist [4] outlining optimal weaning protocols to optimize cardiocirculatory functional restoration during IABP discontinuation. Therefore, the main aim of this study was to assess changes in hemodynamics, coronary circulation, visceral flow, and biochemical markers using rate reduction or stepwise volume deflation for IABP discontinuation.…”

mentioning

confidence: 99%

The Optimal Weaning Strategy for Intraaortic Balloon Counterpulsation: Volume-Based Versus Rate-Based Approach in an Animal Model

Gelsomino

Lozekoot

Lorusso

et al. 2016

The Annals of Thoracic Surgery

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“…The IABP can also be weaned by maintaining a ventricular rate of 1:1 and deflating the balloon over several hours. This leads to a decrease in the counterpulsation and a decrease in diastolic augmentation [25,26]. There are limited studies in the literature that have assessed which weaning method is superior.…”

Section: Weaning and Removalmentioning

confidence: 99%

17. Mechanical Circulatory Support Devices

Paciullo¹,

Baumgartner²,

Roller³

2018

Anticoagulation Therapy

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Heart failure (HF) is a global public health concern that has the potential to reach epidemic proportions. The gold standard for treating end-stage HF remains heart transplantation. Unfortunately, given the scarcity of available organs, alternative means for providing cardiac support are required. Mechanical circulatory support devices (MCSDs) have the potential to treat many patients with end-stage HF. They replace some of the mechanical functions of the failing heart to improve cardiac output and organ perfusion. These include the intra-aortic balloon pump, extracorporeal membrane oxygenation, ventricular assist devices, and the total artificial heart. In this chapter, we will discuss a brief history of MCSD, available devices, indications, patient selection, surgical procedures, postoperative management, complications, and outcomes.

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“…prognostic factors for in-hospital mortality in the CABG patients requiring IABP (7)(8)(9)(10)(11). However, a few papers have referred to weaning protocols and withdrawal indications of IABP (12)(13)(14). We believe that prolonged balloon support is an important issue and early weaning the individuals who need longer support is of great importance, as well.…”

Section: Weaning From Iabp After Cabg Surgery: Impact Of Serum Lactatmentioning

confidence: 99%

“…Elevated serum lactate levels and lactic acidosis after cardiac surgery is an indicator of systemic hypo-perfusion and tissue hypoxia (15)(16)(17). Persistent anaerobic metabolism is an important contributor to inadequate postoperative ventricular function (14,16,17). It has also been shown that early post cardiac surgery hyperlactatemia is an independent risk factor for increase of morbidity and mortality in adults (16).…”

Section: Weaning From Iabp After Cabg Surgery: Impact Of Serum Lactatmentioning

confidence: 99%

Weaning from IABP after CABG Surgery: Impact of Serum Lactate Levels as an Early Predictor

Ladan¹,

Javidi²,

Vahdani

et al. 2016

Int Cardiovasc Res J

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Background: Impaired cardiac performance is a frequent presentation after Coronary Artery Bypass Graft (CABG) surgery. Intra-Aortic Balloon Pump (IABP), as a mechanical support, is lifesaving in many cases of low cardiac output state. IABP is needed to be in place from a few hours to a few days. Weaning is usually done according to patients' hemodynamic response. Up to now, many studies have addressed the withdrawal methods, but few are related to predict the support time. Objectives: This study aimed to evaluate whether high serum lactate levels are early predictors of IABP dependency after CABG surgery. Patients and Methods: This prospective cohort study was performed on 843 patients who underwent CABG surgery from April 2009 to January 2014 in Pars hospital. Among these patients, 47 ones required IABP support and were all entered into our study. Arterial blood samples were collected by 2-hour intervals during the first 12 hours after the operation. Serum lactate levels were compared according to IABP dependency. The data were analyzed using chi-square, t-test, and correlation coefficient and α = 0.05 was considered to be the significance level. Results: Based on the results, 97.8% of the patients (n = 46) were successfully weaned from IABP support and 95.7% (n = 45) survived to discharge from the hospital. Two patients with persistent serum lactate levels > 15 mmol/L in the first 12 hours of IABP support had the worst prognosis. A significant association was found between the mean serum lactate levels ≥ 6 mmol/L in the first 12 hours after the surgery and ≥ 48 hours dependency on IABP (P = 0.030). Conclusions: Prediction of IABP dependency may be possible by measuring serum lactate levels in the first 12 hours after CABG surgery.

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How should I wean my next intra-aortic balloon pump? Differences between progressive volume weaning and rate weaning

Abstract: Intra-aortic balloon pump weaning by volume deflation allowed better hemodynamic and metabolic parameters.

Cited by 22 publications

References 23 publications

The Optimal Weaning Strategy for Intraaortic Balloon Counterpulsation: Volume-Based Versus Rate-Based Approach in an Animal Model

The Optimal Weaning Strategy for Intraaortic Balloon Counterpulsation: Volume-Based Versus Rate-Based Approach in an Animal Model

17. Mechanical Circulatory Support Devices

Weaning from IABP after CABG Surgery: Impact of Serum Lactate Levels as an Early Predictor

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