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PubMed1988

Complications of intra-aortic balloon counterpulsation, with special reference to limb ischemia.

During a 5-year period, intra-aortic balloon pumping (IABP) was performed on 90 patients (3.1% of those undergoing open-heart surgery), using a Percor catheter inserted with Seldinger technique. Overall prognosis was poor; only 46 of the 90 patients were alive at postoperative follow-up averaging 23 months. Limb ischemia arose in 20%, with incidence uninfluenced by catheter insertion technique (percutaneous v. 'open'). Surgical treatment was required for half of the ischemic limbs. Groin hematoma commonly followed percutaneous extraction of IABP catheter, whereas 'open' removal was always hemostatic, with potential for embolectomy. Percutaneous insertion of IABP catheter via the femoral artery is the method of choice in an emergency situation. 'Open' Seldinger technique is preferable in the operating room. For elective IABP catheter removal, the 'open', hemostatic technique is recommended. If limb-threatening ischemia develops, the catheter must be removed. If the patient is IABP-dependent, the contralateral femoral artery or the ascending aorta should be considered as an alternative catheter route.

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PubMedDate not supplied

[Synergic effects of intra-aortic counterpulsation and dopamine in experimental cardiogenic shock with closed thorax].

Having established an easily reproducible, stable, technique for producing cardiogenic shock in dogs, and for applying the intraaortic balloon pump (IABP), a complementary study was carried out in six dogs that were treated for cardiogenic shock with the IABP associated with 8 micrograms/kg/min. of continuous intravenous dopamine. The results were compared with those obtained using only the IABP. It was found that dopamine associated with the IABP reduced the left ventricular end-diastolic pressure by 75.3% and increased the dP/dt and Vmax by 90% and 41.6% respectively. The heart rate rose from 134 (+/- 2.45) to 153.5 (+/- 14.13) beats per minute two hours after treatment. There were no changes in the mean aortic pressure and left ventricular systolic pressure, and diuresis was decreased. It is concluded that the IABP alone produces a significant decrease in the preload and increase in the afterload, but when associated with dopamine, no changes are observed in the afterload, but the preload falls considerably. Moreover, myocardial contractility is increased. Therefore dopamine and the IABP used together have synergic beneficial effects.

Animals↗