Short-term effects of intra-aortic balloon pumping on renal blood flow and renal oxygen consumption in cardiogenic shock

Abstract

Intra-aortic balloon pumping is frequently used in patients with cardiogenic shock when oliguria persists despite maximal pharmacologic support. The objective of this study was to measure the effect of intra-aortic balloon pumping on renal blood flow, renal oxygen delivery, and renal oxygen consumption in such patients. Central hemodynamics, renal blood flow, and oxygen transport were measured in 10 patients in low cardiac output states. Measurements were made with and without intra-aortic balloon counterpulsation. Renal blood flow was measured by continuous renal vein thermodilution. Small improvements were observed in cardiac output (3.1 ± 0.8 vs 3.5 ± 0.8 L/min, P < .01) and pulmonary capillary wedge pressure (22 ± 5.6 vs 19 ± 5.3 mmHg, P < .05), but mean arterial blood pressure was unchanged (69 ± 11 vs 69 ± 5 mmHg, not significant). Baseline renal blood flow was reduced to approximately 37%, renal oxygen delivery to 31%, and renal oxygen consumption to 60% of normal values. No significant improvement was seen in single-kidney renal blood flow (184 ± 108 vs 193 ± 107 mL/min), renal oxygen delivery (28 ± 16 vs 30 ± 16 mL/min), or renal oxygen consumption (4.9 ± 2.0 vs 4.7 ± 2.5 mL/min) in response to 1:1 counterpulsation. In comparison with measurements made during short-term suspension of counterpulsation, 1:1 aortic balloon pumping failed to result in an increase in renal blood flow, oxygen delivery, or oxygen consumption from the low levels observed in these patients.