title: Intra-aortic balloon pump effects on macrocirculation and microcirculation in cardiogenic shock patients supported by venoarterial extracorporeal membrane oxygenation*.
abstract: OBJECTIVE
  This study was designed to assess the effects on macrocirculation and microcirculation of adding an intra-aortic balloon pump to peripheral venoarterial extracorporeal membrane oxygenation in patients with severe cardiogenic shock and little/no residual left ventricular ejection.
  
  
  METHODS
  A prospective, single-center, observational study where macrocirculation and microcirculation were assessed with clinical-, Doppler echocardiography-, and pulmonary artery-derived hemodynamic variables and also cerebral and thenar eminence tissue oxygenation and side-stream dark-field imaging of sublingual microcirculation.
  
  
  METHODS
  A 26-bed tertiary ICU in a university hospital.
  
  
  METHODS
  We evaluated 12 consecutive patients before and 30 minutes after interrupting and restarting intra-aortic balloon pump.
  
  
  METHODS
  Measurements were performed before, and 30 minutes after interrupting and restarting intra-aortic balloon pump.
  
  
  RESULTS
  Stopping intra-aortic balloon pump was associated with higher pulmonary artery-occlusion pressure (19 ± 10 vs 15 ± 8 mm Hg, p = 0.01), increased left ventricular end-systolic (51 ± 13 vs 50 ± 14 mm, p = 0.05) and end-diastolic (55 ± 13 vs 52 ± 14 mm, p = 0.003) dimensions, and decreased pulse pressure (15 ± 13 vs 29 ± 22 mm Hg, p = 0.02). Maximum pulmonary artery-occlusion pressure reduction when the intra-aortic balloon pump was restarted was observed in the seven patients whose pulmonary artery-occlusion pressure was more than 15 mm Hg when intra-aortic balloon pump was off (-6.6 ± 4.3 vs -0.6 ± 3.4 mm Hg, respectively). Thenar eminence and brain tissue oxygenation and side-stream dark-field-assessed sublingual microcirculation were unchanged by stopping and restarting intra-aortic balloon pump.
  
  
  CONCLUSIONS
  Restoring pulsatility and decreasing left ventricular afterload with intra-aortic balloon pump was associated with smaller left ventricular dimensions and lower pulmonary artery pressures but did not affect microcirculation variables in cardiogenic shock patients with little/no residual left ventricular ejection while on peripheral venoarterial extracorporeal membrane oxygenation.
authors.affiliation: 1Medical-Surgical Intensive Care Unit, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. 2Department of Anesthesiology and Critical Care Medicine, Hôpital Bicêtre, Assistance Publique-Hôpitaux de Paris, Université Paris Sud, Le Kremlin-Bicêtre, France. 3Department of Anesthesiology and Critical Care Medicine, UMRS INSERM 956, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France. 4Department of Cardiac Surgery, iCAN, Institute of Cardiometabolism and Nutrition, Hôpital de la Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Université Pierre et Marie Curie, Paris, France.
authors.forename: Thibaut
authors.initials: T
authors.lastname: Petroni
authors.forename: Anatole
authors.initials: A
authors.lastname: Harrois
authors.forename: Julien
authors.initials: J
authors.lastname: Amour
authors.forename: Guillaume
authors.initials: G
authors.lastname: Lebreton
authors.forename: Nicolas
authors.initials: N
authors.lastname: Brechot
authors.forename: Sébastien
authors.initials: S
authors.lastname: Tanaka
authors.forename: Charles-Edouard
authors.initials: CE
authors.lastname: Luyt
authors.forename: Jean-Louis
authors.initials: JL
authors.lastname: Trouillet
authors.forename: Jean
authors.initials: J
authors.lastname: Chastre
authors.forename: Pascal
authors.initials: P
authors.lastname: Leprince
authors.forename: Jacques
authors.initials: J
authors.lastname: Duranteau
authors.forename: Alain
authors.initials: A
authors.lastname: Combes
mesh_terms: D000328:Adult; D000368:Aged; D015199:Extracorporeal Membrane Oxygenation / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D008297:Male; D008833:Microcirculation; D008875:Middle Aged; D011446:Prospective Studies; D012770:Shock, Cardiogenic / Q000503:physiopathology* / Q000601:surgery*; D062606:Tertiary Care Centers