Cerebral hemodynamics with intra-aortic balloon pump: business as usual?
OBJECTIVE
Intra-aortic balloon pump (IABP) is commonly used as mechanical support after cardiac surgery or cardiac shock. Although its benefits for cardiac function have been well documented, its effects on cerebral circulation are still controversial. We hypothesized that transfer function analysis (TFA) and continuous estimates of dynamic cerebral autoregulation (CA) provide consistent results in the assessment of cerebral autoregulation in patients with IABP.


METHODS
Continuous recordings of blood pressure (BP, intra-arterial line), end-tidal CO2, heart rate and cerebral blood flow velocity (CBFV, transcranial Doppler) were obtained (i) 5 min with IABP ratio 1:3, (ii) 5 min, starting 1 min with the IABP-ON, and continuing for another 4 min without pump assistance (IABP-OFF). Autoregulation index (ARI) was estimated from the CBFV response to a step change in BP derived by TFA and as a function of time using an autoregressive moving-average model during removal of the device (ARIt). Critical closing pressure and resistance area-product were also obtained.


RESULTS
ARI with IABP-ON (4.3  ±  1.2) were not different from corresponding values at IABP-OFF (4.7  ±  1.4, p  =  0.42). Removal of the balloon had no effect on ARIt, CBFV, BP, cerebral critical closing pressure or resistance area-product.


CONCLUSIONS
IABP does not disturb cerebral hemodynamics. TFA and continuous estimates of dynamic CA can be used to assess cerebral hemodynamics in patients with IABP. These findings have important implications for the design of studies of critically ill patients requiring the use of different invasive support devices.
Department of Anesthesia, University of São Paulo, São Paulo, Brazil. Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil.
J R
JR
Caldas
R B
RB
Panerai
E
E
Bor-Seng-Shu
J P
JP
Almeida
G S R
GSR
Ferreira
L
L
Camara
R C
RC
Nogueira
M L
ML
Oliveira
F B
FB
Jatene
T G
TG
Robinson
L A
LA
Hajjar
D001794:Blood Pressure; D002560:Cerebrovascular Circulation; D005260:Female; D006339:Heart Rate; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged