RESUMEN
BACKGROUND: The addition of an intra-aortic balloon pump (IABP) during peripheral venoarterial extracorporeal membrane oxygenation (VA ECMO) support has been shown to improve coronary bypass graft flows and cardiac function in refractory cardiogenic shock after cardiac surgery. The purpose of this study was to evaluate the impact of additional IABP support on the cerebral blood flow (CBF) in patients with peripheral VA ECMO following cardiac procedures. METHODS: Twelve patients (mean age 60.40±9.80 years) received VA ECMO combined with IABP support for postcardiotomy cardiogenic shock after coronary artery bypass grafting. The mean CBF in the bilateral middle cerebral arteries was measured with and without IABP counterpulsation by transcranial Doppler. The patients provided their control values. The mean CBF data were divided into two groups (pulsatile pressure greater than 10 mmHg, P group; pulsatile pressure less than 10 mmHg, N group) based on whether the patients experienced cardiac stun. The mean cerebral blood flow in VA ECMO (IABP turned off) alone and VA ECMO with IABP support were compared using the paired t test. RESULTS: All of the patients were successfully weaned from VA ECMO, and eight patients survived to discharge. The addition of IABP to VA ECMO did not change the mean CBF (251.47±79.28 ml/min vs. 251.30±79.47 ml/min, P=0.96). The mean CBF was higher in VA ECMO alone than in VA ECMO combined with IABP support in the N group (257.68±97.21 ml/min vs. 239.47±95.60, P=0.00). The addition of IABP to VA ECMO support increased the mean CBF values significantly compared with VA ECMO alone (261.68±82.45 ml/min vs. 244.43±45.85 ml/min, P=0.00) in the P group. CONCLUSION: These results demonstrate that an IABP significantly changes the CBF during peripheral VA ECMO, depending on the antegrade blood flow by spontaneous cardiac function. The addition of an IABP to VA ECMO support decreased the CBF during cardiac stun, and it increased CBF without cardiac stun.
Asunto(s)
Circulación Cerebrovascular , Oxigenación por Membrana Extracorpórea , Contrapulsador Intraaórtico , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Ultrasonografía Doppler TranscranealRESUMEN
To avoid cerebral hypoxia caused by the imbalance between cerebral oxygen supply and consumption, regional cerebral oxygenation of patients need to be monitored at real time during cardiopulmonary bypass (CPB) surgery, and the physiological parameters can be regulated and emergent treatment can be used according to it. Using the near infrared (NIR) instrument developed by our group, cerebral oxygenation of the patients under cardiac surgery was monitored. The instrument consists of a two-wavelength near infrared light source and two near infrared detectors. Hemoglobin concentration changes of regional cerebral tissue were calculated, and by steady-state spatially resolved spectroscopy (SRS) algorithm, regional cerebral oxygen saturation (rSO2) was also calculated. Physiological parameters of patients, such as mixed venous oxygen saturation (SvO2), were measured by another monitor during CPB. Hemoglobin concentration changes were easily disturbed, but the anti-disturbance ability of rSO2 was good. The value of rSO2 could be detected all over the surgeries, but SvO2 could be detected only during CPB. There were positive correlations between rSO2 and SvO2 in most of the patients, but the correlation coefficients were not very high. This was because SvO2 reflects the saturation of the main venous, but rSO2 reflects regional cerebral oxygenation. So the physiological meaning of rSO2 and SvO2 is different. The results indicate that cerebral oxygenation of patients can be reflected by rSO2 during CPB, while only monitoring SvO2 is not enough.