Body perfusion during adult cardiopulmonary bypass is improved by pulsatile flow with intra-aortic balloon pump.
OBJECTIVE
To evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves body perfusion.


METHODS
158 coronary artery bypass graft (CABG) patients were randomized to linear cardiopulmonary bypass (CPB) (n=71, Group A) or automatic 80 bpm intra-aortic balloon pump (IABP) induced pulsatile CPB (n=87, Group B). We evaluated hemodynamic response by Swan-Ganz catheter, inflammation by cytokines, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate and renal function (estimated glomerular filtration rate (eGFR), creatinine, and incidence of renal insufficiency and failure).


RESULTS
IABP induced Surplus Hemodynamic Energy was 15.8-/+4.9 mmHg, with higher mean arterial pressure during cross-clamping (p=0.001), and lower indexed systemic vascular resistances during cross-clamping (p=0.001) and CPB discontinuation (p=0.034). IL-2 and IL-6 were lower, while IL-10 proved higher in Group B (p<0.05). Group B showed lower chest drainage (p<0.05), transfusions (p<0.05), INR (p<0.05), and AT-III (p=0.001), together with higher platelets, aPTT (p<0.05), fibrinogen (p<0.05) and D-dimer (p<0.05). Transaminases, bilirubin, amylase, lactate were lower in Group B (p<0.05); eGFR was better in Group B from ITU-arrival to 48 hours, both in preoperative kidney disease Stages 1-2 (p<0.03) and Stage 3 (p<0.05), resulting in lower creatinine from ITU-arrival to 48 hours (p<0.03). Incidence of renal insufficiency (p=0.004) and need for renal replacement therapy (p=0.044) was lower in Group B Stage 3. Group B PaO2/FiO2 and lung compliance improved from aortic declamping to the first day (p<0.003) with shorter intubation time (p=0.01).


CONCLUSIONS
Pulsatile flow by IABP improves whole-body perfusion during CPB.
Onorati
F
F
Department of Clinical and Experimental Medicine, Cardiac Surgery Unit, Magna Graecia University Medical School, Catanzaro, Italy. cchumg@hotmail.it
Santarpino
G
G
Rubino
A S
AS
Caroleo
S
S
Dardano
A
A
Scalas
C
C
Gulletta
E
E
Santangelo
E
E
Renzulli
A
A
D000368:Aged; D015415:Biomarkers / Q000097:blood; D001777:Blood Coagulation; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000401:mortality; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D016207:Cytokines / Q000097:blood; D005260:Female; D006324:Heart Arrest, Induced; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D018836:Inflammation Mediators / Q000097:blood; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000401:mortality; D007511:Ischemia / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D008297:Male; D011446:Prospective Studies; D011652:Pulmonary Circulation; D012123:Pulmonary Ventilation; D011673:Pulsatile Flow; D012039:Regional Blood Flow; D013152:Splanchnic Circulation; D018746:Systemic Inflammatory Response Syndrome / Q000097:blood / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D016896:Treatment Outcome
D015415:Biomarkers; D016207:Cytokines; D018836:Inflammation Mediators