Effects of intra-aortic balloon counterpulsation on parameters of tissue oxygenation.
OBJECTIVE
To investigate the effects of intra-aortic balloon pump therapy on parameters of global and regional oxygenation in patients undergoing cardiac surgery.


METHODS
As part of a large surveillance study in cardiac surgery patients (n=266) we retrospectively analyzed the course of 28 patients requiring intra-aortic balloon pump therapy. Patients were grouped according to the time point of pump insertion (during weaning from cardiopulmonary bypass: group early intra-aortic balloon pumping (n=17); after admission to the intensive care unit: group late intra-aortic balloon pumping (n=9). Haemodynamic and tonometric variables, arterial lactate, and use of catecholamines were measured hourly.


RESULTS
Cardiac index increased in both groups after intra-aortic balloon pump insertion (2.2+/-0.5 baseline; 3.4+/-0.8 L min-1 m-2 4 h later (group early intra-aortic balloon pumping); 2.8+/-0.5 baseline, 3.6+/-L min-1 m-2 4 h later (group later intra-aortic balloon pumping), each P<0.05), there were no differences between groups. Arterial lactate values increased in group later intra-aortic balloon pumping after pump insertion to a maximum 2 h later (8.4+/-6.1 mmol L-1 baseline; 12.7+/-7.4 mmol L-1, P<0.05), and decreased continuously afterwards. The difference of arterial and gastric CO2 showed a sharp decrease after pump insertion in group later intra-aortic balloon pumping (26.4+/-9.8 baseline; 7.0+/-11.1 mmHg, P<0.05). There were no differences between groups. Epinephrine doses were higher in group later intra-aortic balloon pumping (P<0.05).


CONCLUSIONS
Intra-aortic balloon pump therapy improved global and regional splanchnic oxygenation in cardiac surgery patients with low-cardiac-output syndrome. Gastro-intestinal tonometry could provide additional information concerning tissue oxygenation. Patients with later intra-aortic balloon pump insertion needed more catecholamine therapy to achieve similar haemodynamic values.
Heinze
H
H
University of Luebeck, Department of Anaesthesiology, Luebeck, and Department of Anaesthesiology, Dietrich-Bonnhoeffer-Klinikum Neubrandenburg, Germany. Hermannheinze@ngi.de
Heringlake
M
M
Schmucker
P
P
Uhlig
T
T
D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D019344:Lactic Acid / Q000097:blood; D008297:Male; D008365:Manometry; D010100:Oxygen / Q000378:metabolism*; D016896:Treatment Outcome
D019344:Lactic Acid; D010100:Oxygen