The Impact of Intraaortic Balloon Counterpulsation on Bypass Graft Flow in Patients with Peripheral ECMO
The Impact of Intraaortic Balloon Counterpulsation on Bypass Graft Flow in Patients with Peripheral ECMO
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DOI：
10.1111/j.1540-8191.2009.00807.x
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发表时间：
2009-05-01
影响因子：
1.6
通讯作者：
Wahlers, Thorsten
中科院分区：
文献类型：
--
作者：
Madershahian, Navid;Liakopoulos, Oliver J.;Wahlers, Thorsten
目的：研究主动脉内球囊反搏(IABP)和非搏动性循环体外膜肺氧合(ECMO)对血流动力学的影响已有大量报道，但IABP和ECMO联合应用对冠状动脉旁路移植血流影响的研究较少。这项研究的目的是评估额外的IABP支持对非搏动性股静脉-动脉ECMO高危患者搭桥术中血流增加程度的影响。方法：6例急诊冠状动脉搭桥术患者，男5例，女1例，平均年龄66.3±2.1岁，射血分数25.0±3.0%。使用渡越时间流量计测量术中移植物流量和搏动指数(PI)。患者提供了他们的控制值。结果：IABP术前平均动脉压为63.6±2.9 mm Hg，IABP支持期间平均动脉压为67.8±2.9 mm Hg(p<；0.0001)。平均搭桥流量从46.8+/-9.6mL/min增加到56.4+/-12.1mL/min(p<；0.005)，增加了17%。PI差异无统计学意义(IABP组为2.6+/-0.2，IABP组为2.6+/-0.3)。结论：我们得出结论：在非搏动性外周ECMO中，IABP诱导的搏动性显著改善冠状动脉搭桥术的血流量(J Card Surg 2009；24：265-268)。
Objective: Numerous reports have been performed to investigate the hemodynamic effects of intraaortic balloon pumping (IABP) and nonpulsatile circulatory extracorporeal membrane oxygenation (ECMO), but studies on its impact on coronary artery bypass graft flow during concomitant use of IABP and ECMO are lacking. The aim of this study was to assess the impact of additional IABP support on the degree of blood flow increase in bypass grafts in high-risk patients with nonpulsatile femoral venoarterial ECMO. Methods: In six emergency coronary artery bypass graft patients (mean age = 66.3 +/- 2.1 years, gender = five males and one female, ejection fraction = 25.0 +/- 3.0%) requiring mechanical circulatory support with ECMO hemodynamic parameters and bypass graft flows were measured with and without IABP counterpulsation. A transit time flowmeter was used for intraoperative graft flow and pulsatility index (PI) measurements. Patients provided their control values. Results: The average value of the mean arterial pressure recorded prior to IABP was 63.6 + 2.9 mmHg and during IABP support 67.8 + 2.9 mmHg (p < 0.0001). IABP augmented the mean bypass graft flow from 46.8 +/- 9.6 mL/min to 56.4 +/- 12.1 mL/min (p < 0.005), resulting in a 17% increase. The difference in the PI was not statistically significant (2.6 +/- 0.2 with IABP, 2.6 +/- 0.3 without IABP). Conclusions: We conclude that IABP-induced pulsatility significantly improves coronary bypass graft flows during nonpulsatile peripheral ECMO.(J Card Surg 2009;24:265-268).