Intraaortic Counterpulsation During Cardiopulmonary Bypass Impairs Distal Organ Perfusion

Lundemoen, Steinar; Kvalheim, Venny Lise; Svendsen, Øyvind; Mongstad, Arve; Andersen, Knut-Jan; Grong, Ketil; Husby, Paul

doi:10.1016/j.athoracsur.2014.08.029

Cited by 21 publications

(19 citation statements)

References 23 publications

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“…Preoperative placement of an intra‐aortic balloon pump may prevent AKI and reduce the incidence of RRT in high‐risk patients by improving perfusion and reducing endothelial activation . Others, however, have suggested that using an intra‐aortic balloon pump as a surrogate to achieve pulsatile perfusion contributes significantly to lowered aortic pressure in the distal portion of aorta and may impair kidney perfusion …”

Section: Resultsmentioning

confidence: 99%

“…158,159 Others, however, have suggested that using an intra-aortic balloon pump as a surrogate to achieve pulsatile perfusion contributes significantly to lowered aortic pressure in the distal portion of aorta and may impair kidney perfusion. 160 Intraoperative. The use of CPB is required for the majority of cardiac surgical procedures.…”

Section: Nonpharmacological Strategiesmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Nadim

Forni

Bïhorac

et al. 2018

JAHA

228

191

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Section: Resultsmentioning

confidence: 99%

Section: Nonpharmacological Strategiesmentioning

confidence: 99%

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Nadim

Forni

Bïhorac

et al. 2018

JAHA

228

191

View full text Add to dashboard Cite

“…Why does the mechanical effect of the IABP increase renal blood flow whereas it reduces perfusion in the mesenteric artery? Apart from the specific myotonic mechanism described above, this could be related to the short distance between the tip of the balloon and the mesenteric branch and to the alterations in flow described immediately beneath the balloon, leading to a reduced perfusion pressure (Lundemoen et al., ). Further research is warranted to clarify this finding.…”

Section: Discussionmentioning

confidence: 99%

Superior mesenteric and renal flow patterns during intra‐aortic counterpulsation

Johnson

Lozekoot

Jong

et al. 2019

Experimental Physiology

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New Findings What is the central question of this study?Visceral ischaemia is one of the most feared complications during use of an intra‐aortic balloon pump. Using an animal model, we measured the flows at the abdominal level directly and examined flow patterns to enable investigation of flow patterns during the use of the intra‐aortic balloon pump. What is the main finding and its importance?We show that there is a significant balloon‐related reduction in superior mesenteric flow in both early and mid‐diastole. Abstract A number of previous studies have shown that blood flow in the visceral arteries is altered during intra‐aortic balloon pump (IABP) treatment. We used a porcine model to analyse the pattern of blood flow into the visceral arteries during IABP use. For this purpose, we measured the superior mesenteric, right renal and left renal flows before and during IABP support, using surgically placed flowmeters surrounding these visceral arteries. The superior mesenteric flow significantly decreased in early diastole (P < 0.001) and in mid‐diastole (P = 0.003 versus early diastole), whereas in late diastole it increased again (P < 0.001 versus mid‐diastole). During systole, the flow was not significantly increased compared with late diastole (P = 0.51), but it was significantly lower than at baseline (both P < 0.001). Flows did not differ between right and left kidneys. Perfusion of either kidney did not change significantly in early diastole (P > 0.05), whereas it decreased significantly in mid‐diastole (P < 0.001), rising dramatically in late diastole (P < 0.001) and with an additional slight increase in systole (P = 0.054). This study provides important insights into abdominal flows during intra‐aortic pump counterpulsation. Furthermore, it supports the need to rethink the balloon design to avoid visceral ischaemia during circulatory assistance.

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“…Although all selected patients met the criteria for cardiogenic shock, there were differences in the severity of conditions. We adopted VIS score to assess the critical conditions of patients (18,21,22), and EuroSCORE to evaluate baseline status of patients (23,24). The results showed that the overall EuroSCORE in patients was 6.48±3.16 points (out of 17 points).…”

Section: Discussionmentioning

confidence: 99%

Clinical application of intra-aortic balloon pump in patients with cardiogenic shock during the perioperative period of cardiac surgery

Jiang

Zhu

et al. 2017

Experimental and Therapeutic Medicine

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Intra-aortic balloon pumps (IABP) have saved many patients with cardiogenic shock during the perioperative period of cardiac surgery. However, the ideal insertion timing is controversial. In the present study, we aimed to optimize the insertion timing, in order to increase the survival rate of the patients. A total of 197 patients with cardiogenic shock during the perioperative period of cardiac surgery and implemented IABP from January 2011 to October 2015 were selected for the study. Patients were divided into five groups on the basis of application timing of IABP: 0–60, 61–120, 121–180, 181–240 and >240 min. The 30-day mortality, application rate of continuous renal replacement therapy (CRRT), duration of mechanical ventilation, duration of hospital stay and hospitalization charges were analyzed in the above groups. The risk factors related to mortality and the occurrence of IABP complications were also analyzed. The mortality in the 0–60, 61–120, 121–180, 181–240 and >240 min groups were 42.17, 36.6, 77.3, 72.7 and 79.3%, respectively. Earlier IABP insertion resulted in less patients receiving CRRT from acute renal failure and less daily hospitalization charges. However, the IABP application timing had no effect on indexes such as hospitalization duration, duration of mechanical ventilation and total hospitalization charges. Multifactor logistic regression analysis indicated that the independent risk factors of death in patients with cardiogenic shock during cardiac surgery were related to IABP support timing and vasoactive-inotropic score (VIS) before balloon insertion. In the first 120 min of cardiogenic shock during the perioperative period of cardiac surgery, IABP application decreased 30-day mortality. Mortality was related with VIS score of patients, which can be used to predict the prognosis of patients with cardiogenic shock.

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Intraaortic Counterpulsation During Cardiopulmonary Bypass Impairs Distal Organ Perfusion

Cited by 21 publications

References 23 publications

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Cardiac and Vascular Surgery–Associated Acute Kidney Injury: The 20th International Consensus Conference of the ADQI (Acute Disease Quality Initiative) Group

Superior mesenteric and renal flow patterns during intra‐aortic counterpulsation

Clinical application of intra-aortic balloon pump in patients with cardiogenic shock during the perioperative period of cardiac surgery

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