Neonatal piglet model of intraaortic balloon pumping: Improved efficacy using echocardiographic timing

Minich, L. LuAnn; Tani, Lloyd Y.; Pantalos, George M.; Bolland, Bridget L.; Knorr, Brett K; Hawkins, John A.

doi:10.1016/s0003-4975(98)00954-0

Cited by 11 publications

(7 citation statements)

References 21 publications

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“…To this end, integration of a high-fidelity micromanometer into the catheter tip may eliminate timing error(s), especially compared to low-fidelity fluid-filled catheters, which introduce gain and phase distortion and tend to drift over time 20 . Indeed, we and other investigators 19 observed that it was easier to identify inflation and deflation timing landmarks in the arterial pressure waveform acquired with a high-fidelity signal. Consequently, timing errors were unlikely responsible for end-diastolic flow reversal.…”

Section: Discussionmentioning

confidence: 72%

“…Similarly, brief timing errors associated with a fluid-filled versus a high-fidelity signal 12 or high-fidelity signal versus echocardiographic timing 19 may reduce counterpulsation efficacy in pediatric patients. A precise signal is required to accurately time inflation and deflation and maximize counterpulsation efficacy in pediatric patients.…”

Section: Discussionmentioning

confidence: 99%

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End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation

Bartoli

Rogers

Ionan

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

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OBJECTIVE Counterpulsation with an intraaortic balloon pump (IABP) has not achieved the same successes or clinical use in pediatric patients as in adults. In a pediatric animal model, IABP efficacy was investigated to determine whether IABP timing with a high-fidelity blood pressure signal may improve counterpulsation therapy versus a low-fidelity signal. METHODS In Yorkshire piglets (n=19, 13.0±0.5 kg) with coronary ligation-induced acute ischemic left ventricular failure, pediatric IABPs (5 or 7cc) were placed in the descending thoracic aorta. Inflation and deflation were timed with traditional criteria from low-fidelity (fluid-filled) and high-fidelity (micromanometer) blood pressure signals during 1:1 support. Aortic, carotid, and coronary hemodynamics were measured with pressure and flow transducers. Myocardial oxygen consumption was calculated from coronary sinus and arterial blood samples. Left ventricular myocardial blood flow and end-organ blood flow were measured with microspheres. RESULTS Despite significant suprasystolic diastolic augmentation and afterload reduction at heart rates of 105±3bmp, left ventricular myocardial blood flow, myocardial oxygen consumption, the myocardial oxygen supply/demand relationship, cardiac output, and end-organ blood flow did not change. Statistically significant end-diastolic coronary, carotid, and aortic flow reversal occurred with IABP deflation. Inflation and deflation timed with a high-fidelity versus low-fidelity signal did not attenuate systemic flow reversal or improve the myocardial oxygen supply/demand relationship. CONCLUSIONS Systemic end-diastolic flow reversal limited counterpulsation efficacy in a pediatric model of acute left ventricular failure. Adjustment of IABP inflation and deflation timing with traditional criteria and a high-fidelity blood pressure waveform did not improve IABP efficacy or attenuate flow reversal. End-diastolic flow reversal may limit the efficacy of IABP counterpulsation therapy in pediatric patients with traditional timing criteria. Investigation of alternative deflation timing strategies is warranted.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation

Bartoli

Rogers

Ionan

et al. 2014

The Journal of Thoracic and Cardiovascular Surgery

View full text Add to dashboard Cite

show abstract

“…3,[10][11][12][13][14] Figure 3 shows the proper position of an intra-aortic balloon catheter. Clinicians should be knowledgeable about the factors that affect IABC efficacy and should include these factors in the assessment of IABP hemodynamics.…”

Section: Efficacy Of Iabcmentioning

confidence: 99%

Intra-aortic Balloon Pump Timing: Review of Evidence Supporting Current Practice

Hanlon-Pena

Quaal

2011

American Journal of Critical Care

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Intra-aortic balloon counterpulsation is the most widely used therapy for support of a compromised left ventricle. The principles of counterpulsation were developed in the 1950s, and intra-aortic balloon pumps have been used for more than 40 years. Despite this long-standing clinical use, many of the timing practices have continued almost unchanged from their inception. One of the most important aspects of the pumps is timing, or synchronizing the action of the device with the cardiac cycle. The principles of timing are based on the physiological objectives of counterpulsation; however, research into alternative timing methods has led to conflicting and often confusing information on the appropriate timing method for a specific clinical situation or patient. Although a body of knowledge is available, much of the research is dated and covers only specific timing methods or populations of patients. Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the pathophysiological effects and goals of intra-aortic balloon pump counterpulsation. 2. Identify factors that affect intra-aortic balloon counterpulsation efficacy and appropriate hemodynamic assessment parameters for evaluating efficacy of counterpulsation therapy. 3. Discuss timing methods, potential timing errors, and considerations for timing of intraaortic balloon pump counterpulsation in specific clinical situations.

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“…Pantalos et al, 8 Minich et al 4 and Elgahwazzi et al 9 reported that the arterial pressure signal, most commonly used for setting IABP timing, can affect IABP efficacy. Pantalos et al 8 found a mean delay between the true cardiac event and arterial waveform of 45 to 60 milliseconds.…”

Section: Signal Quality and Delaysmentioning

confidence: 99%

“…When propagation delays are not accounted for or if the signal is distorted, IABP efficacy can be reduced. Minich et al 4,5 and Pantalos et al 6,8 concluded that higher fidelity signals would reduce timing errors and improve efficacy. Schreuder et al 10 found that use of high-fidelity arterial pressure signals provided greater timing accuracy than did use of other signals, partly because of improved signal quality and reduced delays.…”

Section: Signal Quality and Delaysmentioning

confidence: 99%

Resource Document: Evidence Supporting Current Practice in Timing Assessment

Hanlon-Pena

Quaal

2011

American Journal of Critical Care

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Current practice is an important component of evidence-based practice. This resource provides a discussion of timing practice and assessment guidelines and a detailed description of the impact of physiological and nonphysiological factors on the efficacy of intra-aortic balloon pump (IABP) therapy. Conventional Timing AssessmentTiming assessment is the process of determining if the timing settings are correct relative to the cardiac cycle. Conventional timing dictates that all actions of the IABP occur in diastole, so inflation should occur at the dicrotic notch and deflation before the next systolic ejection. To assess timing, set the IABP at 1:2 assist to allow comparison of assisted and unassisted beats. Figure 1 shows the assessment points.To assess inflation, draw a line (circled 1 on the figure) from visible dicrotic notch to dicrotic notch. The inflation point or V between systole and augmentation should be on or slightly above the line. If the V is too far above the line (more than 3 boxes on the electrocardiographic [ECG] paper), inflation timing is too early. If the dicrotic notch is visible between systole and the augmentation waveform, inflation is too late. In addition, the augmentation pressure should be greater than the systolic pressure.Deflation timing is assessed by identifying the assisted diastole, that is, the diastolic pressure after inflation of the balloon, and comparing it with the unassisted diastole (circled 2 on Figure 1), the native diastolic pressure of the patient. The assisted diastole should be lower than the patient's diastolic pressure. Finally, draw a line from the systolic pressure to the next systolic pressure (circled 3 on Figure 1). The assisted systole, the pressure after assisted diastole, should be lower than the patient's native systole. This finding indicates that the decrease in aortic pressure at end diastole reduced systolic pressure work on the next systolic beat.If the assisted systolic pressure is not lower than the native systolic pressure, deflation is too early (Figure 2A). This situation may occur even when deflation produces a decrease in end-diastolic pressure, but if it occurs well before the next systolic ejection, the left ventricle does not benefit from that pressure

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Neonatal piglet model of intraaortic balloon pumping: Improved efficacy using echocardiographic timing

Cited by 11 publications

References 21 publications

End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation

End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation

Intra-aortic Balloon Pump Timing: Review of Evidence Supporting Current Practice

Resource Document: Evidence Supporting Current Practice in Timing Assessment

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