The Impact of Intraaortic Balloon Counterpulsation on Bypass Graft Flow in Patients with Peripheral ECMO

Abstract

Numerous reports have been performed to investigate the hemodynamic effects of intraaortic balloon pumping (IABP) and nonpulsatile circulatory extracorporeal membrane oxygenation (ECMO), but studies on its impact on coronary artery bypass graft flow during concomitant use of IABP and ECMO are lacking. The aim of this study was to assess the impact of additional IABP support on the degree of blood flow increase in bypass grafts in high-risk patients with nonpulsatile femoral venoarterial ECMO. In six emergency coronary artery bypass graft patients (mean age = 66.3 +/- 2.1 years, gender = five males and one female, ejection fraction = 25.0 +/- 3.0%) requiring mechanical circulatory support with ECMO hemodynamic parameters and bypass graft flows were measured with and without IABP counterpulsation. A transit time flowmeter was used for intraoperative graft flow and pulsatility index (PI) measurements. Patients provided their control values. The average value of the mean arterial pressure recorded prior to IABP was 63.6 + 2.9 mmHg and during IABP support 67.8 + 2.9 mmHg (p < 0.0001). IABP augmented the mean bypass graft flow from 46.8 +/- 9.6 mL/min to 56.4 +/- 12.1 mL/min (p < 0.005), resulting in a 17% increase. The difference in the PI was not statistically significant (2.6 +/- 0.2 with IABP, 2.6 +/- 0.3 without IABP). We conclude that IABP-induced pulsatility significantly improves coronary bypass graft flows during nonpulsatile peripheral ECMO.