Thorac Cardiovasc Surg 2018; 66(S 01): S1-S110
DOI: 10.1055/s-0038-1627838
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Sunday, February 18, 2018
DGTHG: IABP/ECC/LVAD
Georg Thieme Verlag KG Stuttgart · New York

Does Supplemental Intra-aortic Balloon Pumping to Extracorporeal Membrane Oxygenation Improve End-organ Blood Flow and Function? - An Experimental Study

I. Djordjevic
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
,
A. C. Deppe
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
,
J. Maier
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
,
M. Elskamp
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
,
T. Mühlbauer
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
,
S. Gerfer
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
,
A. Sterner-Kock
2   Department of Experimental Medicine, University Hospital Cologne, Cologne, Germany
,
I. Slottosch
3   Department of Cardiothoracic Surgery, University Hospital Magdeburg, Magdeburg, Germany
,
A. Paunel-Görgülü
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
,
T. Wahlers
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
,
O. Liakopoulos
1   Department of Cardiothoracic Surgery, University Hospital Cologne, Cologne, Germany
› Author Affiliations
Further Information

Publication History

Publication Date:
22 January 2018 (online)

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Objectives: Veno-arterial extracorporeal membrane oxygenation (vaECMO) is increasingly used as salvage therapy in cardiac surgery. Non-pulsatile blood flow and blood activation related to ECMO therapy is known to induce end-organ malperfusion and systemic inflammatory response syndrome (SIRS). We investigated in a porcine ECMO model whether simultaneous intra-aortic balloon pump (IABP) with restoration of blood flow pulsatility improves end-organ perfusion and attenuates the SIRS.

Methods: Thirteen female pigs (weight 60.8 ± 4.3 kg) were divided into three groups: Sham-operated group (n = 3), ECMO group (vaECMO; n = 5) and IABP group (vaECMO + IABP with 1:1 augmentation; n = 5). Peripheral ECMO support was implemented through the femoral vessels (ECMO flow: 3.0 - 4.0 L/min, target mean arterial pressure (APmean): 50–60 mm Hg). Systemic hemodynamics, including left and right ventricular pressure, cardiac index (CI), coronary (CoBF) and carotid artery (CaBF) blood flow were continuous measured for 10 hours. Serial blood samples were obtained to analyze markers of inflammation (NETs: neutrophil extracellular traps), oxidative stress (lactate) and cardio-renal injury.

Results: Systemic hemodynamics (APmean: 60 ± 1 (Sham) versus 65 ± 7 (ECMO) versus 61 ± 6 (IABP) mmHg; p = n.s.) and CI (3.3 ± 0.2 (Sham) versus 3.0 ± 0.6 (ECMO) versus 3.1 ± 0.3 (IABP) L/min/m 2; p = n.s.) were comparable between groups. Adding IABP to ECMO failed to increase CoBF (46 ± 31 ECMO versus 36 ± 4 IABP; p = 0.7) and CaBF (151 ± 29 ECMO versus 151 ± 49 IABP mL/min; p = 0.99). Lactate levels (p < 0.01), creatinine levels (p = 0.07), Troponin levels (p < 0.01) and NETs (p = 0.05) were significantly increased in the IABP group compared with the ECMO group after 10 hours of extracorporeal support.

Conclusions: Our experimental study indicates that supplemental IABP support to ECMO therapy fails to improve end-organ perfusion and systemic hemodynamics and does not attenuate inflammatory and oxidative injury.