Treating severe cardiogenic shock by large counterpulsation volumes.
BACKGROUND
Intraaortic balloon pumping is known to be ineffective in severe cardiogenic shock. The efficacy of balloon volumes larger than those commonly used is examined.


METHODS
In 18 dogs with severe experimental cardiogenic shock (systolic aortic pressure < 60 mm Hg, aortic flow < 45 mL.min-1.kg-1) the effect of three intraaortic balloon volumes (15, 30, and 45 mL) and a 60-mL paraaortic pump was examined.


RESULTS
The 45-mL balloon covering the full length of the aorta induced the highest (+ 12.4 +/- 2.2 mL.min-1.kg-1; mean +/- standard error of the mean) and the 15-mL balloon the lowest increase in aortic flow (F = 14.6, p < 0.0001). Only the 45-mL balloon increased (p < 0.05) urine output and renal artery flow. The 60-mL paraaortic pump induced the highest (F = 10.72, p < 0.002) increase (+ 36.6 +/- 6.5 mL.min-1.kg-1) in aortic flow compared to the three balloons. An 80- to 100-mL paraaortic pump maintained the life of 3 patients in severe cardiogenic shock for 4 hours, 8 days, and 54 days, whereas a 40-mL conventional balloon was completely ineffective.


CONCLUSIONS
Experimental and clinical data indicate that the effectiveness of intraaortic balloon pumping in severe cardiogenic shock may be improved by increasing the volume of the balloon (i.e., until it fully occupies the aorta).
Stamatelopoulos
S F
SF
Department of Clinical Therapeutics, Athens University Medical School, Greece.
Nanas
J N
JN
Saridakis
N S
NS
Zakopoulos
N A
NA
Lyropoulos
S
S
Makrakis
G
G
Liberidis
A
A
Moulopoulos
S D
SD
D000818:Animals; D001011:Aorta / Q000503:physiopathology; D001783:Blood Flow Velocity; D001794:Blood Pressure; D004285:Dogs; D006339:Heart Rate; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation / Q000379:methods*; D012077:Renal Artery / Q000503:physiopathology; D012770:Shock, Cardiogenic / Q000503:physiopathology / Q000628:therapy*; D014556:Urine