Practical Pearl

Neurocritical Care

, Volume 13, Issue 1, pp 101-108

Intra-Aortic Balloon Pump Counterpulsation in the Setting of Subarachnoid Hemorrhage, Cerebral Vasospasm, and Neurogenic Stress Cardiomyopathy. Case Report and Review of the Literature

  • Christos LazaridisAffiliated withNeurosciences Intensive Care Unit, Departments of Neurology and Neurosurgery, Medical University of South Carolina Email author 
  • , Gustavo PradillaAffiliated withDepartment of Neurological Surgery, Johns Hopkins University School of Medicine
  • , Paul A. NyquistAffiliated withDepartment of Anesthesiology/Critical Care Medicine, Johns Hopkins University School of MedicineDepartment of Neurology, Johns Hopkins University School of Medicine
  • , Rafael J. TamargoAffiliated withDepartment of Neurological Surgery, Johns Hopkins University School of Medicine

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Abstract

Background

The management of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) can be often complicated by the presence of stunned myocardium and left ventricular failure. Vasopressors and inotropes are commonly used to optimize mean arterial pressure (MAP) and cerebral perfusion pressure (CPP). Intra-aortic balloon counterpulsation pump (IABP) may be indicated in the management of these patients.

Methods

We report the case of a 55-year-old patient who suffered an aSAH complicated by severe left ventricular failure, who subsequently developed symptomatic cerebral vasospasm. Left ventricular failure precluded traditional hemodynamic augmentation, and IABP was successfully used instead, which allowed for reinstitution of hypertensive hypervolemic therapy and prevented delayed cerebral ischemia.

Results

A review of the literature conducted on symptomatic cerebral vasospasm after aSAH and severe left ventricular failure revealed seven publications describing 14 patients with aSAH treated with an IABP during the period of vasospasm.

Conclusions

Intra-aortic balloon counterpulsation pump (IABP) is used for hemodynamic support of patients in cardiogenic shock and its use in the setting of aSAH, cardiomyopathy, and cerebral vasospasm can be beneficial in preventing delayed ischemic deficits.

Keywords

Intra-aortic balloon counterpulsation Subarachnoid hemorrhage Cerebral vasospasm Takotsubo cardiomyopathy