title: Balloon-pump counterpulsation for management of severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage.
abstract: OBJECTIVE
  To evaluate the use of intraaortic balloon pump (IABP) placement to counter severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage (SAH).
  
  
  METHODS
  From August 2006 to October 2011, eight patients (seven women, mean age 47 years ± 5) with aneurysmal SAH underwent IABP placement. The modified Rankin scale (mRS) was used to assess outcome at discharge and long-term follow-up.
  
  
  RESULTS
  Most patients presented in poor Hunt & Hess grade (grade III, 25%; grade IV, 62.5%; grade V, 12.5%). Three patients underwent surgical clipping, and five patients underwent endovascular treatment. All patients had severe cardiogenic shock, with a mean ejection fraction of 21%. One patient (12.5%) experienced transient left leg ischemia attributable to the IABP. No patient deaths occurred. At discharge, one patient was moderately disabled (mRS = 3), two patients were moderately to severely disabled (mRS, 4), and five patients were severely disabled (mRS = 5). The seven patients available for long-term follow-up (mean, 11.25 months) showed substantial functional improvements. Two patients exhibited no significant disability (mRS = 1), two patients exhibited only slight disability (mRS = 2), and 3 patients exhibited moderate to severe disability (mRS = 4).
  
  
  CONCLUSIONS
  In select patients, particularly young women with poor-grade SAH, balloon-pump counterpulsation may serve as a useful adjunct in the management of severe cardiac dysfunction after SAH. Further investigation is necessary to define the optimal patient population for this technique.
authors.affiliation: Division of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona, USA.
authors.forename: Andrew F
authors.initials: AF
authors.lastname: Ducruet
authors.forename: Felipe C
authors.initials: FC
authors.lastname: Albuquerque
authors.forename: R Webster
authors.initials: RW
authors.lastname: Crowley
authors.forename: Richard
authors.initials: R
authors.lastname: Williamson
authors.forename: James
authors.initials: J
authors.lastname: Forseth
authors.forename: Cameron G
authors.initials: CG
authors.lastname: McDougall
mesh_terms: D000328:Adult; D019090:Case Management; D015908:Counterpulsation / Q000009:adverse effects / Q000379:methods*; D057510:Endovascular Procedures; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D020127:Recovery of Function; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications* / Q000601:surgery; D016896:Treatment Outcome; D020301:Vasospasm, Intracranial / Q000628:therapy