Abstract
IntroductionThe Intra-Aortic Balloon Pump (IABP) is frequently used to mechanically support the heart. There is evidence that IABP improves microvascular flow during cardiogenic shock but its influence on the human microcirculation in patients deemed ready for discontinuing IABP support has not yet been studied. Therefore we used sidestream dark field imaging (SDF) to test our hypothesis that human microcirculation remains unaltered with or without IABP support in patients clinically ready for discontinuation of mechanical support.MethodsWe studied 15 ICU patients on IABP therapy. Measurements were performed after the clinical decision was made to remove the balloon catheter. We recorded global hemodynamic parameters and performed venous oximetry during maximal IABP support (1:1) and 10 minutes after temporarily stopping the IABP therapy. At both time points, we also recorded video clips of the sublingual microcirculation. From these we determined indices of microvascular perfusion including perfused vessel density (PVD) and microvascular flow index (MFI).ResultsCeasing IABP support lowered mean arterial pressure (74 ± 8 to 71 ± 10 mmHg; P = 0.048) and increased diastolic pressure (43 ± 10 to 53 ± 9 mmHg; P = 0.0002). However, at the level of the microcirculation we found an increase of PVD of small vessels <20 μm (5.47 ± 1.76 to 6.63 ± 1.90; P = 0.0039). PVD for vessels >20 μm and MFI for both small and large vessels were unaltered. During the procedure global oxygenation parameters (ScvO2/SvO2) remained unchanged.ConclusionsIn patients deemed ready for discontinuing IABP support according to current practice, SDF imaging showed an increase of microcirculatory flow of small vessels after ceasing IABP therapy. This observation may indicate that IABP impairs microvascular perfusion in recovered patients, although this warrants confirmation.
Highlights
The Intra-Aortic Balloon Pump (IABP) is frequently used to mechanically support the heart
Patients were only included if and when the responsible intensive care unit (ICU) physician had made the decision that the subjects were clinically ready for discontinuation of Intra-Aortic Balloon Pump- (IABP-)support
This is in contrast with the loss of IABP-induced raise of mean arterial pressure in these patients [1,2,3] and, perhaps more importantly, in contrast with mixed venous oxygen saturation (SvO2) or central venous oxygen saturation (ScvO2) values, which remained
Summary
The Intra-Aortic Balloon Pump (IABP) is frequently used to mechanically support the heart. We used sidestream dark field imaging (SDF) to test our hypothesis that human microcirculation remains unaltered with or without IABP support in patients clinically ready for discontinuation of mechanical support. The recent emergence of Orthogonal Polarization Spectral imaging and its successor sidestream dark field imaging (SDF) has enabled imaging of the human microcirculation in real time [5,6,7]. These techniques have been used to characterize the microcirculation in various clinical situations including cardiogenic shock
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