Intra-aortic Balloon Pump Use With Extra Corporeal Membrane Oxygenation-A Mock Circulation Loop Study.

Area of Science:

• Cardiovascular Physiology
• Mechanical Circulatory Support

Background:

• Venoarterial extracorporeal membrane oxygenation (ECMO) is a critical therapy for refractory cardiogenic shock.
• Peripheral ECMO can cause left ventricular distention, potentially mitigated by intra-aortic balloon pump (IABP) support.

Purpose of the Study:

• To quantify the hemodynamic effects of combining IABP with ECMO under various simulated heart failure conditions.
• To evaluate the impact on left ventricular end-diastolic pressure (LVEDP), left ventricular end-diastolic volume (LVEDV), and coronary and cerebral blood flow.

Main Methods:

• A mock circulatory loop was used to simulate different severities of isolated left ventricular failure and biventricular failure.
• Hemodynamic parameters were measured during ECMO support alone and with concomitant IABP support.

Main Results:

• ECMO increased left ventricular volumes and pressures in simulated heart failure states.
• IABP reduced LVEDP by 3-7% and LVEDV by 1-10%.
• IABP had minimal impact on cerebral blood flow but variable effects on coronary flow, increasing diastolic flow (23-50%) while reducing mean flow (up to 30%).

Conclusions:

• The addition of IABP to ECMO can reduce left ventricular workload.
• The effectiveness of IABP in conjunction with ECMO is dependent on the degree of ventricular contractility.
• Careful patient selection and consideration of ventricular function are crucial when implementing concomitant IABP and ECMO therapy.