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Body perfusion during adult cardiopulmonary bypass is improved by pulsatile flow with intra-aortic balloon pump.

AbstractPURPOSE:
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.
AuthorsF Onorati, G Santarpino, A S Rubino, S Caroleo, A Dardano, C Scalas, E Gulletta, E Santangelo, A Renzulli
JournalThe International journal of artificial organs (Int J Artif Organs) Vol. 32 Issue 1 Pg. 50-61 (Jan 2009) ISSN: 0391-3988 [Print] United States
PMID19241364 (Publication Type: Journal Article, Randomized Controlled Trial)
Chemical References
  • Biomarkers
  • Cytokines
  • Inflammation Mediators
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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