The effects of intra-aortic balloon pump support on macrocirculation and tissue microcirculation in patients with cardiogenic shock.
OBJECTIVE
It was the aim of this study to evaluate the effects of intra-aortic balloon pump (IABP) counterpulsation on sublingual microcirculation as a model for tissue perfusion.


METHODS
In 13 patients with cardiogenic shock treated with IABP, the IABP assist ratio was reduced from 1:1 to 1:8 for 15 min. Using sidestream dark field imaging, 117 movie files of the sublingual microcirculation were obtained and quantified at different IABP assist ratios at 3 time points: 1:1 (T0), 1:8 (T1) and 1:1 (T2), respectively. Data are presented as the median and interquartile range.


RESULTS
The median age of the patients was 59 years (range 56-73), and 62% were males. Discontinuation of IABP decreased the mean arterial pressure [75 mm Hg (71-84) at T0 vs. 69 mm Hg (64-79) at T1; p < 0.001], cardiac index [2.9 l/min/m2 (1.6-3.3) at T0 vs. 2.4 l/min/m2 (1.5-2.8) at T1; p = 0.005] and cardiac power index [0.46 W/m2 (0.29-0.59) at T0 vs. 0.36 W/m2 (0.24-0.50) at T1; p = 0.006]. However, these modest changes in macrohemodynamics did not significantly influence sublingual perfused capillary density and capillary red blood cell velocity (p = 0.28 and 0.73, respectively).


CONCLUSIONS
A temporary, modest decrease in microcirculatory driving force, induced by lowering the IABP assist ratio, does not impair sublingual microcirculatory perfusion as measured by a novel 2-dimensional imaging technique.
Thoraxcenter, Departments of Cardiology and Intensive Care Medicine, Erasmus Medical Center, 's-Gravendijkwal 230, Rotterdam NL-3015 CE, The Netherlands. c.denuil@erasmusmc.nl
Corstiaan A
CA
den Uil
Wim K
WK
Lagrand
Martin
M
van der Ent
Lucia S D
LS
Jewbali
Jasper J
JJ
Brugts
Peter E
PE
Spronk
Maarten L
ML
Simoons
D000368:Aged; D015908:Counterpulsation; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006785:Hospitals, University; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D008991:Monitoring, Physiologic; D009060:Mouth Floor / Q000098:blood supply*; D012770:Shock, Cardiogenic / Q000503:physiopathology / Q000601:surgery*; D016896:Treatment Outcome