Serial hemodynamics during intra-aortic balloon counterpulsation for cardiogenic shock.

Abstract

The use of intra-aortic balloon counterpulsation (IABC) has achieved some success in the treatment of cardiogenic shock, but there has been little objective documentation of the serial hemodynamic effects of counterpulsation in man. Six patients who satisfied strict criteria for refractory cardiogenic shock were treated with IABC. The following determinations were made serially: systemic blood pressure (BP), pulmonary artery pressures (PAP), pulmonary artery wedge pressure (PAW), cardiac index (CI), stroke volume index (SVI), and A-VO 2 difference. The average duration of balloon assist was 5.8 days (range 1.5 to 21 days). There was immediate improvement in all patients in that pressors could be maintained at lower levels. Although mean systolic BP did not change significantly from control values, augmented diastolic BP was maintained between 112 and 120 mm Hg. Initially, there were significant decreases in mean PAP (–13.4 mm Hg, P < 0.02), mean PAW (–10 mm Hg, P < 0.01), and A-VO 2 difference (–2.12 ml/100 ml) and increases in CI (+ 1.02 L/min/m 2 , P < 0.05). The improvement in diastolic BP, CI, and A-VO 2 difference persisted in each patient, but mean PAP increased from 22.6 to 32.3 mm Hg ( P < 0.05) and mean PAW from 14.4 to 22 mm Hg ( P < 0.05) by the fourth day of IABC. We conclude that IABC causes marked immediate improvement in hemodynamic variables and that prolonged survival is possible. However, progressive elevation of mean PAP and PAW, reflecting deterioration of left ventricular function, occurs and can prohibit a successful outcome with IABC alone.