Advertisement

Clinical Research in Cardiology

, Volume 98, Issue 8, pp 469–475 | Cite as

Acute microflow changes after stop and restart of intra-aortic balloon pump in cardiogenic shock

  • Christian JungEmail author
  • Christoph Rödiger
  • Michael Fritzenwanger
  • Julia Schumm
  • Alexander Lauten
  • Hans R. Figulla
  • Markus Ferrari
Original Paper

Abstract

Background

The intra-aortic balloon counter pulsation (IABP) is the most frequently used method of mechanical cardiac support in cardiogenic shock (CS). Microcirculatory impairment correlates with outcome in critically ill patients. We therefore investigated the acute influence of IABP therapy on sublingual microflow in patients with CS.

Methods

Sidestream darkfield intravitalmicroscopy was used in 13 patients with severe CS. The sublingual microvascular bed (10–100 μm) was examined according to current guidelines. We measured microflow in means of microvascular flow index at baseline and after intentional stop of IABP support. A computerized model was used for blinded off-line analysis.

Results

Microflow in vessels 10–50 μm in diameter was improved during IABP support (P < 0.001). Norepinephrine had a negative effect on the response to IABP related microflow improvement. Cardiac Perfusion Index (product of Cardiac Power index and microflow) correlated best with blood lactate levels.

Conclusions

It was the aim of this study to evaluate the acute influence of IABP therapy on microflow in vivo. In this setting we found that IABP therapy improves sublingual microflow. Future studies should investigate Cardiac Perfusion Index under such conditions with respect to clinical decision making.

Keywords

IABP Microcirculation Cardiogenic shock OPS SDF 

Supplementary material

Supplementary material 1 (WMV 3912 kb)

References

  1. 1.
    Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, Hochman JS, Krumholz HM, Kushner FG, Lamas GA, Mullany CJ, Ornato JP, Pearle DL, Sloan MA, Smith SC Jr, Alpert JS, Anderson JL, Faxon DP, Fuster V, Gibbons RJ, Gregoratos G, Halperin JL, Hiratzka LF, Hunt SA, Jacobs AK (2004) ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction–executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (writing committee to revise the 1999 guidelines for the management of patients with acute myocardial Infarction). Circulation 110:588–636PubMedCrossRefGoogle Scholar
  2. 2.
    Arnolda L, McGrath BP, Johnston CI (1991) Systemic and regional effects of vasopressin and angiotensin in acute left ventricular failure. Am J Physiol 260:H499–H506PubMedGoogle Scholar
  3. 3.
    Bhayana JN, Scott SM, Sethi GK, Takaro T (1979) Effects of intraaortic balloon pumping on organ perfusion in cardiogenic shock. J Surg Res 26:108–113PubMedCrossRefGoogle Scholar
  4. 4.
    Chierego M, Verdant C, De Backer D (2006) Microcirculatory alterations in critically ill patients. Minerva Anestesiol 72:199–205PubMedGoogle Scholar
  5. 5.
    Christoph A, Prondzinsky R, Russ M, Janusch M, Schlitt A, Lemm H, Reith S, Werdan K, Buerke M (2008) Early and sustained haemodynamic improvement with levosimendan compared to intraaortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction. Acute Card Care 10:49–57PubMedCrossRefGoogle Scholar
  6. 6.
    De Backer D, Creteur J, Dubois M-J, Sakr Y, Vincent J-L (2004) Microvascular alterations in patients with acute severe heart failure and cardiogenic shock. Am Heart J 147:91–99PubMedCrossRefGoogle Scholar
  7. 7.
    De Backer D, Creteur J, Preiser J-C, Dubois M-J, Vincent J-L (2002) Microvascular Blood Flow Is Altered in Patients with Sepsis. Am J Respir Crit Care Med 166:98–104PubMedCrossRefGoogle Scholar
  8. 8.
    De Backer D, Hollenberg S, Boerma C, Goedhart P, Buchele G, Ospina-Tascon G, Dobbe I, Ince C (2007) How to evaluate the microcirculation: report of a round table conference. Crit Care 11:R101PubMedCrossRefGoogle Scholar
  9. 9.
    Dunkman WB, Leinbach RC, Buckley MJ, Mundth ED, Kantrowitz AR, Austen WG, Sanders CA (1972) Clinical and hemodynamic results of intraaortic balloon pumping and surgery for cardiogenic shock. Circulation 46:465–477PubMedGoogle Scholar
  10. 10.
    Gowda RM, Fox JT, Khan IA (2008) Cardiogenic shock: basics and clinical considerations. Int J Cardiol 123:221–228PubMedCrossRefGoogle Scholar
  11. 11.
    Groner W, Winkelman JW, Harris AG, Ince C, Bouma GJ, Messmer K, Nadeau RG (1999) Orthogonal polarization spectral imaging: a new method for study of the microcirculation. Nat Med 5:1209–1212PubMedCrossRefGoogle Scholar
  12. 12.
    Hilberman M, Derby GC, Spencer RJ, Stinson EB (1981) Effect of the intra-aortic balloon pump upon postoperative renal function in man. Crit Care Med 9:85–89PubMedCrossRefGoogle Scholar
  13. 13.
    Janssens U, Graf J, Koch KC, vom Dahl J, Hanrath P (2000) Gastric tonometry in patients with cardiogenic shock and intra-aortic balloon counterpulsation. Crit Care Med 28:3449–3455PubMedCrossRefGoogle Scholar
  14. 14.
    Jung C, Ferrari M, Gradinger R, Fritzenwanger M, Pfeifer R, Schlosser M, Poerner TC, Brehm BR, Figulla HR (2008) Evaluation of the microcirculation during extracorporeal membrane-oxygenation. Clin Hemorheol Microcirc 40:311–314PubMedGoogle Scholar
  15. 15.
    Jung C, Ferrari M, Roediger C, Fritzenwanger M, Goebel B, Lauten A, Pfeifer R, Figulla HR (2009) Evaluation of the sublingual microcirculation in cardiogenic shock. Clin Hemorheol Microcirc (in press)Google Scholar
  16. 16.
    Kantrowitz A, Tjonneland S, Freed PS, Phillips SJ, Butner AN, Sherman JL Jr (1968) Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA 203:113–118PubMedCrossRefGoogle Scholar
  17. 17.
    Kellum JA, Pinsky MR (2002) Use of vasopressor agents in critically ill patients. Curr Opin Crit Care 8:236–241PubMedCrossRefGoogle Scholar
  18. 18.
    Kern MJ, Aguirre FV, Tatineni S, Penick D, Serota H, Donohue T, Walter K (1993) Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically ill patients. J Am Coll Cardiol 21:359–368PubMedCrossRefGoogle Scholar
  19. 19.
    Knotzer H, Hasibeder WR (2007) Microcirculatory function monitoring at the bedside—a view from the intensive care. Physiol Meas 28:R65–R86PubMedCrossRefGoogle Scholar
  20. 20.
    LeDoux D, Astiz ME, Carpati CM, Rackow EC (2000) Effects of perfusion pressure on tissue perfusion in septic shock. Crit Care Med 28:2729–2732PubMedCrossRefGoogle Scholar
  21. 21.
    Papaioannou TG, Stefanadis C (2005) Basic principles of the intraaortic balloon pump and mechanisms affecting its performance. ASAIO J 51:296–300PubMedCrossRefGoogle Scholar
  22. 22.
    Santa-Cruz RA, Cohen MG, Ohman EM (2006) Aortic counterpulsation: a review of the hemodynamic effects and indications for use. Catheter Cardiovasc Interv 67:68–77PubMedCrossRefGoogle Scholar
  23. 23.
    Sjauw KD, Engström AE, Henriques J (2007) Percutaneous mechanical cardiac assist in myocardial infarction. Where are we now, where are we going? Acute Cardiac Care 9:222–230PubMedCrossRefGoogle Scholar
  24. 24.
    Sjauw KD, Engstrom AE, Vis MM, van der Schaaf RJ, Baan J Jr, Koch KT, de Winter RJ, Piek JJ, Tijssen JG, Henriques JP (2009) A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 30:459–468PubMedCrossRefGoogle Scholar
  25. 25.
    Sugita Y, Emoto H, Morita K, Suzuki K, Arai T (1985) The effect of intraaortic balloon pumping (IABP) on pulmonary circulation. Trans Am Soc Artif Intern Organs 31:389–394PubMedGoogle Scholar
  26. 26.
    Takami Y, Masumoto H (2008) Effects of intra-aortic balloon pumping on graft flow in coronary surgery: an intraoperative transit-time flowmetric study. Ann Thorac Surg 86:823–827PubMedCrossRefGoogle Scholar
  27. 27.
    Turek Z, Cerny V, Parizkova R (2007) Noninvasive in vivo assessment of the skeletal muscle and small intestine serous surface microcirculation in rat: sidestream dark-field (SDF) imaging. Physiol Res 57:365–371PubMedGoogle Scholar
  28. 28.
    Valente S, Lazzeri C, Vecchio S, Giglioli C, Margheri M, Bernardo P, Comeglio M, Chiocchini S, Gensini GF (2007) Predictors of in-hospital mortality after percutaneous coronary intervention for cardiogenic shock. Int J Cardiol 114:176–182PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Christian Jung
    • 1
    Email author
  • Christoph Rödiger
    • 1
  • Michael Fritzenwanger
    • 1
  • Julia Schumm
    • 1
  • Alexander Lauten
    • 1
  • Hans R. Figulla
    • 1
  • Markus Ferrari
    • 1
  1. 1.Clinic of Internal Medicine IFriedrich-Schiller-UniversityJenaGermany

Personalised recommendations