Reymond Philippe, Bendjelid Karim, Giraud Raphaël, Richard Gérald, Murith Nicolas, Cikirikcioglu Mustafa, Huber Christoph
Charles Hahn Hemodynamic Propulsion Laboratory, Medical Faculty, University of Geneva, 1211 Geneva, Switzerland.
Division of Cardiovascular Surgery, Department of Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland.
J Clin Med. 2021 Nov 16;10(22):5333. doi: 10.3390/jcm10225333.
ECMO is the most frequently used mechanical support for patients suffering from low cardiac output syndrome. Combining IABP with ECMO is believed to increase coronary artery blood flow, decrease high afterload, and restore systemic pulsatile flow conditions. This study evaluates that combined effect on coronary artery flow during various load conditions using an in vitro circuit. In doing so, different clinical scenarios were simulated, such as normal cardiac output and moderate-to-severe heart failure. In the heart failure scenarios, we used peripheral ECMO support to compensate for the lowered cardiac output value and reach a default normal value. The increase in coronary blood flow using the combined IABP-ECMO setup was more noticeable in low heart rate conditions. At baseline, intermediate and severe LV failure levels, adding IABP increased coronary mean flow by 16%, 7.5%, and 3.4% (HR 60 bpm) and by 6%, 4.5%, and 2.5% (HR 100 bpm) respectively. Based on our in vitro study results, combining ECMO and IABP in a heart failure setup further improves coronary blood flow. This effect was more pronounced at a lower heart rate and decreased with heart failure, which might positively impact recovery from cardiac failure.
体外膜肺氧合（ECMO）是治疗低心排血量综合征患者最常用的机械支持手段。主动脉内球囊反搏（IABP）联合ECMO被认为可增加冠状动脉血流量、降低高后负荷并恢复全身搏动性血流状态。本研究使用体外循环装置评估了在各种负荷条件下该联合治疗对冠状动脉血流的影响。在此过程中，模拟了不同的临床场景，如正常心排血量和中重度心力衰竭。在心力衰竭场景中，我们使用外周ECMO支持来补偿降低的心排血量值并达到默认的正常值。在心率较低的情况下，使用IABP-ECMO联合装置使冠状动脉血流量增加更为明显。在基线、中度和重度左心室衰竭水平时，添加IABP分别使冠状动脉平均血流量在心率60次/分时增加16%、7.5%和3.4%，在心率100次/分时增加6%、4.5%和2.5%。基于我们的体外研究结果，在心力衰竭治疗中联合使用ECMO和IABP可进一步改善冠状动脉血流。这种效果在心率较低时更为明显，并随心力衰竭程度加重而减弱，这可能对心力衰竭的恢复产生积极影响。
