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Influence of intra-aortic balloon pumping on cerebral blood flow pattern in patients after cardiac surgery

Published online by Cambridge University Press:  19 April 2005

A. Schachtrupp ,
H. Wrigge ,
T. Busch ,
W. Buhre  and
A. Weyland
A. Schachtrupp
Affiliation:
Technical University Aachen, Department of General Surgery, Aachen, Germany
H. Wrigge
Affiliation:
University of Bonn, Department of Anaesthesiology and Intensive Care Medicine, Bonn, Germany
T. Busch
Affiliation:
Technical University Aachen, Department of Cardiac Surgery, Aachen, Germany
W. Buhre
Affiliation:
Technical University Aachen, Department of Anaesthesiology and Intensive Care Medicine, Aachen, Germany
A. Weyland
Affiliation:
Klinikum Oldenburg, Department of Anaesthesiology and Intensive Care Medicine, Oldenburg, Germany
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Abstract

Summary

Background and objective: The effects of intra-aortic balloon pumping (IABP) on cerebral perfusion are still a matter of debate. End-diastolic reversal of blood flow in cerebral arteries has been observed in a small number of patients. We prospectively investigated the incidence and the amount of transient cerebral artery blood flow reversal during balloon pumping in patients recovering from cardiac surgery.

Methods: In 23 patients receiving IABP support, blood flow velocities in the right middle cerebral artery were assessed by transcranial Doppler-sonography. Additionally, systemic haemodynamics were monitored. In each patient, measurements were performed at three different pump settings: without support, assist ratio 1 : 1 and assist ratio 1 : 2.

Results: In 8 of 23 patients, balloon pumping caused a transient diastolic reversal of blood flow in the middle cerebral artery during balloon deflation. Antegrade mean flow velocity in the middle cerebral artery significantly increased from 57 ± 27 to 61 ± 26 (assist ratio 1 : 1) and 61 ± 29 cm s−1 (assist ratio 1 : 2) (P < 0.05). Taking transient blood flow reversal into account, net mean flow velocity did not increase with balloon pump support. Systemic haemodynamic parameters remained unchanged.

Conclusion: Left ventricular support with IABP significantly changed flow patterns in basal cerebral arteries of our patients. In 35% of patients, support resulted in a transient reversal of intracranial blood flow which counterbalanced a slight increase in mean antegrade flow.

Keywords

INTRA-AORTIC BALLOON PUMPINGBLOOD FLOW VELOCITYCEREBROVASCULAR CIRCULATIONULTRASONOGRAPHY, Doppler, transcranial
Type
Original Article
Information
European Journal of Anaesthesiology , Volume 22 , Issue 3 , March 2005 , pp. 165 - 170
Copyright
2005 European Society of Anaesthesiology

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