Document Type : Original Article(s)

Authors

1 Department of Cardiovascular Surgery, Chamran Hospital, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

2 Cardiac Rehabilitation Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

BACKGROUND: Some patients require intra-aortic balloon pump (IABP) after coronary artery bypass graft (CABG) surgery. IABP can be adjusted to different frequencies such as 1:1, 1:2, or 1:3. In this study, we tried to compare the effect of 1:1 and 1:2 frequencies of IABP on hemodynamic status of the patients after CABG surgery.
METHODS: In this experimental study, all patients using IABP after CABG surgery were entered the study as pretest and posttest groups. The study could not be blinded because of the clearness of posttest group for the same echocardiographist. The pretest group included patients using a 1:1 frequency of IABP device. The posttest group included patients in the pretest group who were exposed to a 1:2 frequency for 20 minutes. In both groups, on the moderate dose of inotropic support, hemodynamic parameters of patients including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume (SV), and velocity time integral (VTI) in the aorta during systole were measured. Both groups were compared using Wilcoxon signed rank test. SPSS software was used for analysis and P < 0.05 was considered to be statistically significant.
RESULTS: Twelve patients were entered into the study. Three patients were excluded because of open chest and instability of vital signs. Nine patients completed the study. 3 patients were men and 6 were women. The mean age was 58.32 ± 13.18 years. MAP in 1:1 frequency was significantly higher than 1:2 (P = 0.043); however, there was no significant difference between 1:1 and 1:2 in other hemodynamic parameters, namely CO, CI, SV, HR, and VTI.
CONCLUSION: In patients on moderate dose of inotropes, IABP frequencies of 1:1 and 1:2 have the same effect on hemodynamic parameters such as CI, SBP, DBP, HR, and left ventricular outflow tract (LVOT) VTI; meanwhile, MAP remains higher in 1:1 frequency.

Keywords

  1. Mottahedi B, esfehanizadeh J, Alizadeh K, Abbasi Shaye Z. The evaluation of survival in patients who need intra aortic balloon pump (IABP) after cardiac surgery. J Cardiothorac Med 2014; 2(4): 227-30.
  2. Krishna M, Zacharowski K. Principles of intra-aortic balloon pump counterpulsation. Continuing Education in Anaesthesia, Critical Care and Pain 2009; 9(1): 24-8.
  3. Jiang X, Zhu Z, Ye M, Yan Y, Zheng J, Dai Q, et al. Clinical application of intra-aortic balloon pump in patients with cardiogenic shock during the perioperative period of cardiac surgery. Exp Ther Med 2017; 13(5): 1741-8.
  4. Limbert VM, Amiri AM. Intra-aortic balloon pump for patients with cardiac conditions: An update on available techniques and clinical applications. Reports 2019; 2(3): 19.
  5. Gelsomino S, Renzulli A, Rubino AS, Romano SM, Luca F, Valente S, et al. Effects of 1:1, 1:2 or 1:3 intra-aortic balloon counterpulsation/heart support on coronary haemodynamics and cardiac contractile efficiency in an animal model of myocardial ischaemia/reperfusion. Eur J Cardiothorac Surg 2012; 42(2): 325-32.
  6. Kolyva C, Pantalos GM, Pepper JR, Khir AW. Does conventional intra-aortic balloon pump trigger timing produce optimal hemodynamic effects in vivo? Int J Artif Organs 2015; 38(3): 146-53.
  7. Alexander JH, Smith PK. Coronary-artery bypass grafting. N Engl J Med 2016; 374(20): 1954-64.
  8. malakmohamadi m, marage s. Echocardiographic versus fick method for determination of cardiac output in children with various congenital heart disease. J Shahrekord Univ Med Sci 2003; 5(3): 12-20. [In Persian].
  9. Andreoli TE, Cecil RLF, Carpenter CCJ, Griggs RC, Loscalzo J. Cecil essentials of medicine. Philadelphia, PA: W.B. Saunders; 2001.
  10. Brotto V, Rafferty K. Clinical dosage calculations. Melbourne, Australia: Cengage Learning Australia; 2019.
  11. Wilson WC, Grande CM, Hoyt DB. Trauma critical care. New York, NY: CRC Press; 2007.
  12. Beers MF. Physician's Drug Handbook. Philadelphia, PA: Lippincott Williams & Wilkins; 2007.
  13. Tariq S, Aronow WS. Use of inotropic agents in treatment of systolic heart failure. Int J Mol Sci 2015; 16(12): 29060-8.
  14. Graham CA, Parke TR. Critical care in the emergency department: shock and circulatory support. Emerg Med J 2005; 22(1): 17-21.
  15. Hollenberg SM, Ahrens TS, Annane D, Astiz ME, Chalfin DB, Dasta JF, et al. Practice parameters for hemodynamic support of sepsis in adult patients: 2004 update. Crit Care Med 2004; 32(9): 1928-48.
  16. Burridge N, Deidun D. Australian injectable drugs handbook. Melbourne, Australia: Society of Hospital Pharmacists of Australia; 2011.
  17. Khir AW, Price S, Henein MY, Parker KH, Pepper JR. Intra-aortic balloon pumping: effects on left ventricular diastolic function. Eur J Cardiothorac Surg 2003; 24(2): 277-82.
  18. Kolyva C, Pantalos GM, Giridharan GA, Pepper JR, Khir AW. Discerning aortic waves during intra-aortic balloon pumping and their relation to benefits of counterpulsation in humans. J Appl Physiol (1985) 2009; 107(5): 1497-503.