Intra-aortic balloon pump counterpulsation in the management of concomitant cerebral vasospasm and cardiac failure after subarachnoid hemorrhage: technical case report.
We report two patients who had symptomatic cerebral vasospasm and cardiac failure after aneurysmal subarachnoid hemorrhage and who were treated successfully with intra-aortic balloon pump counterpulsation therapy. Both patients developed congestive heart failure and pulmonary edema while receiving postoperative hypertensive, hypervolemic, hemodilutional (Triple-H) therapy for symptomatic cerebral vasospasm. Both cases of cardiac failure were refractory to maximum pressor and inotropic infusions. Intra-aortic balloon pump counterpulsation was used to optimize cardiac performance to allow continuation of Triple-H therapy and to maintain adequate cerebral perfusion in an attempt to decrease the risk of cerebral ischemic complications. Both patients have had good long-term outcomes. These two cases illustrate the potential usefulness of the intra-aortic balloon pump as an adjunct to Triple-H therapy in patients with symptomatic cerebral vasospasm and cardiac failure. To our knowledge, this report documents the first clinical application of this adjunctive therapy for vasospasm after aneurysmal subarachnoid hemorrhage.
Apostolides
P J
PJ
Division of Neurological Surgery, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA.
Greene
K A
KA
Zabramski
J M
JM
Fitzgerald
J W
JW
Spetzler
R F
RF
D000368:Aged; D017542:Aneurysm, Ruptured / Q000601:surgery*; D003131:Combined Modality Therapy; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D002532:Intracranial Aneurysm / Q000601:surgery*; D002546:Ischemic Attack, Transient / Q000628:therapy*; D008875:Middle Aged; D011183:Postoperative Complications / Q000628:therapy*; D013345:Subarachnoid Hemorrhage / Q000628:therapy*