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Effects of intra-aortic balloon counterpulsation on parameters of tissue oxygenation

Published online by Cambridge University Press:  27 January 2006

H. Heinze ,
M. Heringlake ,
P. Schmucker  and
T. Uhlig
H. Heinze
Affiliation:
University of Luebeck, Department of Anaesthesiology, Luebeck, Germany
M. Heringlake
Affiliation:
University of Luebeck, Department of Anaesthesiology, Luebeck, Germany
P. Schmucker
Affiliation:
University of Luebeck, Department of Anaesthesiology, Luebeck, Germany
T. Uhlig
Affiliation:
University of Luebeck, Department of Anaesthesiology, Dietrich-Bonnhoeffer-Klinikum Neubrandenburg, Neubrandenburg, Germany
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Summary

Background and objective: To investigate the effects of intra-aortic balloon pump therapy on parameters of global and regional oxygenation in patients undergoing cardiac surgery. Methods: As part of a large surveillance study in cardiac surgery patients (n = 266) we retrospectively analyzed the course of 28 patients requiring intra-aortic balloon pump therapy. Patients were grouped according to the time point of pump insertion (during weaning from cardiopulmonary bypass: group early intra-aortic balloon pumping (n = 17); after admission to the intensive care unit: group late intra-aortic balloon pumping (n = 9). Haemodynamic and tonometric variables, arterial lactate, and use of catecholamines were measured hourly. Measurements and results: Cardiac index increased in both groups after intra-aortic balloon pump insertion (2.2 ± 0.5 baseline; 3.4 ± 0.8 L min−1 m−2 4 h later (group early intra-aortic balloon pumping); 2.8 ± 0.5 baseline, 3.6 ± L min−1 m−2 4 h later (group later intra-aortic balloon pumping), each P < 0.05), there were no differences between groups. Arterial lactate values increased in group later intra-aortic balloon pumping after pump insertion to a maximum 2 h later (8.4 ± 6.1 mmol L−1 baseline; 12.7 ± 7.4 mmol L−1, P < 0.05), and decreased continuously afterwards. The difference of arterial and gastric CO2 showed a sharp decrease after pump insertion in group later intra-aortic balloon pumping (26.4 ± 9.8 baseline; 7.0 ± 11.1 mmHg, P < 0.05). There were no differences between groups. Epinephrine doses were higher in group later intra-aortic balloon pumping (P < 0.05). Conclusions: Intra-aortic balloon pump therapy improved global and regional splanchnic oxygenation in cardiac surgery patients with low-cardiac-output syndrome. Gastro-intestinal tonometry could provide additional information concerning tissue oxygenation. Patients with later intra-aortic balloon pump insertion needed more catecholamine therapy to achieve similar haemodynamic values.

Keywords

TONOMETRY, gastric tonometryCO2-gapSPLANCHNIC CIRCULATIONCOUNTERPULSATIONINTRA-AORTIC BALLOON PUMPINGLACTIC ACIDOSISINTENSIVE CARECARDIAC SURGICAL PROCEDURESCARDIOGENIC SHOCK
Type
EACTA Original Article
Information
European Journal of Anaesthesiology , Volume 23 , Issue 7 , July 2006 , pp. 555 - 562
Copyright
© 2006 European Society of Anaesthesiology

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