Balloon-pump counterpulsation for management of severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage

To evaluate the use of intraaortic balloon pump (IABP) placement to counter severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage (SAH).

From August 2006 to October 2011, eight patients (seven women, mean age 47 years ± 5) with aneurysmal SAH underwent IABP placement. The modified Rankin scale (mRS) was used to assess outcome at discharge and long-term follow-up.

Most patients presented in poor Hunt & Hess grade (grade III, 25%; grade IV, 62.5%; grade V, 12.5%). Three patients underwent surgical clipping, and five patients underwent endovascular treatment. All patients had severe cardiogenic shock, with a mean ejection fraction of 21%. One patient (12.5%) experienced transient left leg ischemia attributable to the IABP. No patient deaths occurred. At discharge, one patient was moderately disabled (mRS = 3), two patients were moderately to severely disabled (mRS, 4), and five patients were severely disabled (mRS = 5). The seven patients available for long-term follow-up (mean, 11.25 months) showed substantial functional improvements. Two patients exhibited no significant disability (mRS = 1), two patients exhibited only slight disability (mRS = 2), and 3 patients exhibited moderate to severe disability (mRS = 4).

In select patients, particularly young women with poor-grade SAH, balloon-pump counterpulsation may serve as a useful adjunct in the management of severe cardiac dysfunction after SAH. Further investigation is necessary to define the optimal patient population for this technique.