Abstract | PURPOSE: To evaluate if the use of an intra-aortic balloon pump (IABP) during cardioplegic arrest improves body perfusion. METHODS: 158 coronary artery bypass graft (CABG) patients were randomized to linear cardiopulmonary bypass (CPB) (n=71, Group A) or automatic 80 bpm intra-aortic balloon pump (IABP) induced pulsatile CPB (n=87, Group B). We evaluated hemodynamic response by Swan-Ganz catheter, inflammation by cytokines, coagulation and fibrinolysis, transaminase, bilirubin, amylase, lactate and renal function (estimated glomerular filtration rate (eGFR), creatinine, and incidence of renal insufficiency and failure). RESULTS: IABP induced Surplus Hemodynamic Energy was 15.8-/+4.9 mmHg, with higher mean arterial pressure during cross-clamping (p=0.001), and lower indexed systemic vascular resistances during cross-clamping (p=0.001) and CPB discontinuation (p=0.034). IL-2 and IL-6 were lower, while IL-10 proved higher in Group B (p<0.05). Group B showed lower chest drainage (p<0.05), transfusions (p<0.05), INR (p<0.05), and AT-III (p=0.001), together with higher platelets, aPTT (p<0.05), fibrinogen (p<0.05) and D-dimer (p<0.05). Transaminases, bilirubin, amylase, lactate were lower in Group B (p<0.05); eGFR was better in Group B from ITU-arrival to 48 hours, both in preoperative kidney disease Stages 1-2 (p<0.03) and Stage 3 (p<0.05), resulting in lower creatinine from ITU-arrival to 48 hours (p<0.03). Incidence of renal insufficiency (p=0.004) and need for renal replacement therapy (p=0.044) was lower in Group B Stage 3. Group B PaO2/FiO2 and lung compliance improved from aortic declamping to the first day (p<0.003) with shorter intubation time (p=0.01). CONCLUSION: Pulsatile flow by IABP improves whole-body perfusion during CPB.
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Authors | F Onorati, G Santarpino, A S Rubino, S Caroleo, A Dardano, C Scalas, E Gulletta, E Santangelo, A Renzulli |
Journal | The International journal of artificial organs
(Int J Artif Organs)
Vol. 32
Issue 1
Pg. 50-61
(Jan 2009)
ISSN: 0391-3988 [Print] United States |
PMID | 19241364
(Publication Type: Journal Article, Randomized Controlled Trial)
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Chemical References |
- Biomarkers
- Cytokines
- Inflammation Mediators
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Topics |
- Aged
- Biomarkers
(blood)
- Blood Coagulation
- Cardiopulmonary Bypass
(adverse effects, mortality)
- Coronary Artery Bypass
(adverse effects, mortality)
- Cytokines
(blood)
- Female
- Heart Arrest, Induced
- Hemodynamics
- Hospital Mortality
- Humans
- Inflammation Mediators
(blood)
- Intra-Aortic Balloon Pumping
(adverse effects, mortality)
- Ischemia
(blood, etiology, physiopathology, prevention & control)
- Male
- Prospective Studies
- Pulmonary Circulation
- Pulmonary Ventilation
- Pulsatile Flow
- Regional Blood Flow
- Splanchnic Circulation
- Systemic Inflammatory Response Syndrome
(blood, etiology, physiopathology, prevention & control)
- Treatment Outcome
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