Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing, P.R. China.
School of Public Health, Capital Medical University, Beijing, P.R. China.
ESC Heart Fail. 2022 Aug;9(4):2610-2617. doi: 10.1002/ehf2.13981. Epub 2022 May 29.
To investigate the impact of intra-aortic balloon pump (IABP) on the regional haemodynamics of patients with severe cardiogenic shock undergoing femoro-femoral veno-arterial extracorporeal membrane oxygenation (VA-ECMO).
From July 2017 to April 2018, a total of 39 adult patients with cardiogenic shock receiving both IABP and ECMO for circulatory support were enrolled consecutively in a university-affiliated cardiac surgery intensive care unit. The blood flow rates (BFRs) of the bilateral femoral artery (IABP side: iFA, ECMO side: eFA) and carotid artery (left: LCA, right: RCA) and the velocity time integral (VTI) of aortic root were assessed by ultrasonography and compared when IABP was on and off. Seventeen of 39 (43.6%) patients survived to discharge, and 29 (74.4%) survived on ECMO. A total of 172 pairs of data (IABP on and off) were collected in this study, measured on the median of 2.0 (1.0, 4.5) days after patients received VA-ECMO. The BFR on both sides of FA (iFA: 176.4 ± 104.5 vs. 152.2 ± 139.8 mL/min, P < 0.01; eFA: 299.3 ± 279.9 vs. 242.4 ± 258.8 mL/min, P < 0.01) and the aortic VTI (10.1 ± 4.4 vs. 8.5 ± 4.4 cm, P < 0.01) decreased significantly when turning the IABP off, while the BFR on both sides of CA remained unchanged (LCA: 555.7 ± 326.9 vs. 578.6 ± 328.0 mL/min, P = 0.27; RCA: 550.0 ± 331.1 vs. 533.0 ± 303.5 mL/min, P = 0.30). The LCA BFR dramatically increased after turning the IABP off (296.8 ± 129.7 vs. 401.4 ± 278.1 mL/min, P = 0.02) in patients with cardiac stunning (defined as pulse pressure ≤ 5 mmHg). However, there was no significant difference in LCA BFR between IABP-On and IABD-Off (359.6 ± 105.4 mL/min vs. 389.6 ± 139.3 mL/min, P = 0.31) in patients with cardiac stunning receiving a higher ECMO blood flow (> 3.5 L/min).
Concomitant IABP used in patients undergoing femoro-femoral VA-ECMO was associated with increased aortic VTI and BFR in bilateral FA. The change in CA BFR depended on cardiac function. A decreased LCA BFR was observed in patients with cardiac stunning when IABP was turned on, which might be compensated by a higher ECMO blood flow. Further study is needed to confirm the relationship between BFR and extremities and neurological complications.
研究主动脉内球囊反搏（IABP）对接受股-股静脉-动脉体外膜肺氧合（VA-ECMO）治疗的严重心源性休克患者的区域血液动力学的影响。
从 2017 年 7 月至 2018 年 4 月，连续纳入了 39 例因循环支持而同时接受 IABP 和 ECMO 的成人心源性休克患者。通过超声心动图评估双侧股动脉（IABP 侧：iFA，ECMO 侧：eFA）和颈动脉（左：LCA，右：RCA）的血流速度（BFR）和主动脉根部的速度时间积分（VTI），并比较 IABP 开启和关闭时的数值。39 例患者中 17 例（43.6%）存活至出院，29 例（74.4%）在 ECMO 上存活。本研究共收集了 172 对（IABP 开启和关闭）数据，在患者接受 VA-ECMO 后中位数为 2.0（1.0，4.5）天进行测量。当关闭 IABP 时，双侧 FA 的 BFR（iFA：176.4±104.5 与 152.2±139.8 mL/min，P<0.01；eFA：299.3±279.9 与 242.4±258.8 mL/min，P<0.01）和主动脉 VTI（10.1±4.4 与 8.5±4.4 cm，P<0.01）显著降低，而双侧 CA 的 BFR 保持不变（LCA：555.7±326.9 与 578.6±328.0 mL/min，P=0.27；RCA：550.0±331.1 与 533.0±303.5 mL/min，P=0.30）。当关闭 IABP 时，心脏震击（定义为脉搏压≤5 mmHg）患者的 LCA BFR 显著增加（296.8±129.7 与 401.4±278.1 mL/min，P=0.02）。然而，在心脏震击且 ECMO 血流较高（>3.5 L/min）的患者中，LCA BFR 在 IABP-On 和 IABD-Off 之间没有显著差异（359.6±105.4 与 389.6±139.3 mL/min，P=0.31）。
在接受股-股 VA-ECMO 的患者中同时使用 IABP 与双侧 FA 的主动脉 VTI 和 BFR 增加有关。CA BFR 的变化取决于心功能。当 IABP 开启时，心脏震击患者的 LCA BFR 降低，这可能被更高的 ECMO 血流所代偿。需要进一步的研究来确认 BFR 与四肢和神经并发症之间的关系。
