title: Use of Intra-aortic- Balloon Pump Counterpulsation in Patients with Symptomatic Vasospasm Following Subarachnoid Hemorrhage and Neurogenic Stress Cardiomyopathy.
abstract: BACKGROUND
  Intra-aortic counterpulsation balloon pumps (IABPs) have been widely used to augment hemodynamics in critically ill patients with cardiogenic shock and have recently been proposed as a management strategy for subarachnoid hemorrhage (SAH) patients with neurogenic stress cardiomyopathy (NSC). Prior case series have described the use of IABP as a means to manage cardiogenic shock in this patient population; however, we sought to describe our experience with IABP as a means to wean vasopressor requirement while augmenting hemodynamics and maintaining pressures at goal.
  
  
  METHODS
  Five patients were identified from a single center, prospective, observational cohort study that received an IABP for the management of ischemia related to cerebral vasospasm in the setting of NSC. We evaluated all cases for efficacy of IABP in reducing vasopressor requirement, and complications.
  
  
  RESULTS
  Vasopressor requirements were reduced by a mean of 50% (range 25-65%) following IABPs placement within 24-48 h. There were no significant complications from IABPs. Out of the five patients, the outcome in three cases was favorable (mRS≤1). Two patients suffered delayed cerebral ischemia (DCI), one patient passed away due to severe sepsis, and one patient was left with severe disability. Only one patient required anticoagulation and that was for a preexisting deep venous thrombosis.
  
  
  CONCLUSIONS
  The use of IABPs may be beneficial as an adjunctive therapy in SAH patients with concomitant symptomatic vasospasm and NSC.
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Fawaz
authors.initials: F
authors.lastname: Al-Mufti
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Morris
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Shouri
authors.initials: S
authors.lastname: Lahiri
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: William
authors.initials: W
authors.lastname: Roth
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jens
authors.initials: J
authors.lastname: Witsch
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA.
authors.forename: Iona
authors.initials: I
authors.lastname: Machado
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA; Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Sachin
authors.initials: S
authors.lastname: Agarwal
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA; Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Soojin
authors.initials: S
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Philip M
authors.initials: PM
authors.lastname: Meyers
authors.affiliation: Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: E Sander
authors.initials: ES
authors.lastname: Connolly
authors.affiliation: Departments of Neurology, Columbia University Medical Center, New York, NY, USA; Department of Neurosurgery, Columbia University Medical Center, New York, NY, USA.
authors.forename: Jan
authors.initials: J
authors.lastname: Claassen
keywords: Cardiomyopathy; cerebral vasospasm; intra-aortic balloon pump; subarachnoid hemorrhage