Acute microflow changes after stop and restart of intra-aortic balloon pump in cardiogenic shock.
BACKGROUND
The intra-aortic balloon counter pulsation (IABP) is the most frequently used method of mechanical cardiac support in cardiogenic shock (CS). Microcirculatory impairment correlates with outcome in critically ill patients. We therefore investigated the acute influence of IABP therapy on sublingual microflow in patients with CS.


METHODS
Sidestream darkfield intravitalmicroscopy was used in 13 patients with severe CS. The sublingual microvascular bed (10-100 microm) was examined according to current guidelines. We measured microflow in means of microvascular flow index at baseline and after intentional stop of IABP support. A computerized model was used for blinded off-line analysis.


RESULTS
Microflow in vessels 10-50 microm in diameter was improved during IABP support (P < 0.001). Norepinephrine had a negative effect on the response to IABP related microflow improvement. Cardiac Perfusion Index (product of Cardiac Power index and microflow) correlated best with blood lactate levels.


CONCLUSIONS
It was the aim of this study to evaluate the acute influence of IABP therapy on microflow in vivo. In this setting we found that IABP therapy improves sublingual microflow. Future studies should investigate Cardiac Perfusion Index under such conditions with respect to clinical decision making.
Clinic of Internal Medicine I, Friedrich-Schiller-University, Jena, Germany. christian.jung@med.uni-jena.de
Christian
C
Jung
Christoph
C
Rödiger
Michael
M
Fritzenwanger
Julia
J
Schumm
Alexander
A
Lauten
Hans R
HR
Figulla
Markus
M
Ferrari
D000368:Aged; D001783:Blood Flow Velocity; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D008297:Male; D008833:Microcirculation; D012770:Shock, Cardiogenic / Q000503:physiopathology* / Q000534:rehabilitation*; D013361:Sublingual Gland / Q000098:blood supply* / Q000503:physiopathology*; D016896:Treatment Outcome