title: The Optimal Weaning Strategy for Intraaortic Balloon Counterpulsation: Volume-Based Versus Rate-Based Approach in an Animal Model.
abstract: BACKGROUND
  Changes in hemodynamics, coronary circulation, visceral flow, and biochemical marker rate reduction or volume deflation for intraaortic balloon pump discontinuation were assessed.
  
  
  METHODS
  Twelve healthy pigs were randomly assigned to two groups, the rate-based (RB, n = 6) and volume-based weaning groups (VB, n = 6). Hemodynamics and visceral and coronary flows were measured at baseline after 2 hours of intraaortic balloon pump 1:1, during the first 5 hours of weaning (frequency rate reduced to 1:2 in the RB group and volume decreased by 10%/h in the VB group), after 1 hour of frequency rate 1:3 in the RB group or a volume decrease by 75% in the VB group, 2 hours after withdrawal, and 4 hours after withdrawal.
  
  
  RESULTS
  The animals weaned by progressive VB deflation showed a greater degree of vasodilation, better cardiac output and stroke volume, fewer negative values of cardiac cycle efficiency, and higher dP/dTmax compared with those weaned by RB reduction (p < 0.05 for all). The VB group also exhibited increased coronary flow, lower oxygen consumption of the myocardium, and coronary resistance during VB weaning (p < 0.05 for all). The serum lactate level was lower in the VB group at each experimental point (p < 0.05 for all), but visceral flows were scarcely affected by the weaning method.
  
  
  CONCLUSIONS
  Volume reduction was the most effective weaning method considering that frequency reduction weaning was responsible for significant negative effects on hemodynamics and coronary circulation.
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Heart and Vessels, Careggi Hospital, Florence, Italy. Electronic address: sandro.gelsomino@maastrichtuniversity.nl.
authors.forename: Sandro
authors.initials: S
authors.lastname: Gelsomino
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Pieter W J
authors.initials: PW
authors.lastname: Lozekoot
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Roberto
authors.initials: R
authors.lastname: Lorusso
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Monique J
authors.initials: MJ
authors.lastname: de Jong
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Orlando
authors.initials: O
authors.lastname: Parise
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Francesco
authors.initials: F
authors.lastname: Matteucci
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Fabiana
authors.initials: F
authors.lastname: Lucà
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Narendra
authors.initials: N
authors.lastname: Kumar
authors.affiliation: Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Romano
authors.affiliation: Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
authors.forename: Gian Franco
authors.initials: GF
authors.lastname: Gensini
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Cardiothoracic Surgery, University Hospital, Brussels, Belgium.
authors.forename: Mark
authors.initials: M
authors.lastname: La Meir
authors.affiliation: Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Jos G
authors.initials: JG
authors.lastname: Maessen
mesh_terms: D000818:Animals; D002302:Cardiac Output / Q000502:physiology*; D003326:Coronary Circulation / Q000502:physiology; D004195:Disease Models, Animal; D004562:Electrocardiography; D006439:Hemodynamics / Q000502:physiology*; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000379:methods*; D007442:Intubation, Intratracheal / Q000379:methods; D008991:Monitoring, Physiologic / Q000379:methods; D011897:Random Allocation; D012680:Sensitivity and Specificity; D013318:Stroke Volume / Q000502:physiology*; D013552:Swine; D013997:Time Factors; D014886:Weaning