当前位置： SCI文献检索 > CRITICAL CARE MEDICINE期刊下所有文献 > Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation*.

Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation*.

Abstract：

OBJECTIVES:This study was designed to assess the effects on macrocirculation and microcirculation of adding an intra-aortic balloon pump to peripheral venoarterial extracorporeal membrane oxygenation in patients with severe cardiogenic shock and little/no residual left ventricular ejection. DESIGN:A prospective, single-center, observational study where macrocirculation and microcirculation were assessed with clinical-, Doppler echocardiography-, and pulmonary artery-derived hemodynamic variables and also cerebral and thenar eminence tissue oxygenation and side-stream dark-field imaging of sublingual microcirculation. SETTING:A 26-bed tertiary ICU in a university hospital. PATIENTS:We evaluated 12 consecutive patients before and 30 minutes after interrupting and restarting intra-aortic balloon pump. INTERVENTIONS:Measurements were performed before, and 30 minutes after interrupting and restarting intra-aortic balloon pump. MEASUREMENTS AND MAIN RESULTS:Stopping intra-aortic balloon pump was associated with higher pulmonary artery-occlusion pressure (19 ± 10 vs 15 ± 8 mm Hg, p = 0.01), increased left ventricular end-systolic (51 ± 13 vs 50 ± 14 mm, p = 0.05) and end-diastolic (55 ± 13 vs 52 ± 14 mm, p = 0.003) dimensions, and decreased pulse pressure (15 ± 13 vs 29 ± 22 mm Hg, p = 0.02). Maximum pulmonary artery-occlusion pressure reduction when the intra-aortic balloon pump was restarted was observed in the seven patients whose pulmonary artery-occlusion pressure was more than 15 mm Hg when intra-aortic balloon pump was off (-6.6 ± 4.3 vs -0.6 ± 3.4 mm Hg, respectively). Thenar eminence and brain tissue oxygenation and side-stream dark-field-assessed sublingual microcirculation were unchanged by stopping and restarting intra-aortic balloon pump. CONCLUSIONS:Restoring pulsatility and decreasing left ventricular afterload with intra-aortic balloon pump was associated with smaller left ventricular dimensions and lower pulmonary artery pressures but did not affect microcirculation variables in cardiogenic shock patients with little/no residual left ventricular ejection while on peripheral venoarterial extracorporeal membrane oxygenation.

journal_name

Crit Care Med

journal_title

Critical care medicine

authors

Petroni T,Harrois A,Amour J,Lebreton G,Brechot N,Tanaka S,Luyt CE,Trouillet JL,Chastre J,Leprince P,Duranteau J,Combes A

doi

10.1097/CCM.0000000000000410

subject

Has Abstract

pub_date

2014-09-01 00:00:00

pages

2075-82

issue

eissn

0090-3493

issn

1530-0293

journal_volume

pub_type

杂志文章

在线工具

Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation*.