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Caldas+et+al_2017_Physiol._Meas._10.1088_1361-6579_aa68c4.pdf (1.01 MB)

Cerebral hemodynamic with intra-aortic balloon pump: business as usual?

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journal contribution
posted on 2017-05-22, 14:21 authored by Juliana Caldas, Ronney B. Panerai, Edson Bor-Seng-Shu, Juliano Almeida, Graziela Ferreira, Ligia Cunha, Ricardo Nogueira, Marcelo Oliveira, Fabio Jatene, Thompson Robinson, Ludhmila Hajjar
Intra-aortic balloon pump (IABP) is commonly used as mechanical support after cardiac surgery or cardiac shock. Although its benefits for cardiac function have been well documented, its effects on cerebral circulation are still controversial. We hypothesized that transfer function analysis (TFA) and continuous estimates of dynamic cerebral autoregulation (CA) provide consistent results in the assessment of cerebral autoregulation in patients with IABP. Continuous recordings of blood pressure (BP, intra-arterial line), end-tidal CO2, heart rate and cerebral blood flow velocity (CBFV, transcranial Doppler) were obtained i) 5 minutes with IABP ratio 1:3, ii) 5 minutes, starting 1 minute with the IABP-ON, and continuing for another 4 minutes without pump assistance (IABP-OFF). Autoregulation index (ARI) was estimated from the CBFV response to a step change in BP derived by TFA and as a function of time using an autoregressive moving-average model during removal of the device (ARIt). Critical closing pressure and resistance area-product were also obtained. ARI with IABP-ON (4.3 ± 1.2) were not different from corresponding values at IABP-OFF (4.7 ± 1.4, p=0.42). Removal of the balloon had no effect on ARIt, CBFV, BP, cerebral critical closing pressure or resistance area-product. IABP does not disturb cerebral hemodynamics. TFA and continuous estimates of dynamic CA can be used to assess cerebral hemodynamics in patients with IABP. These findings have important implications for the design of studies of critically ill patients requiring the use of different invasive support devices.

History

Citation

Physiological Measurement, 2017, in press

Author affiliation

/Organisation/COLLEGE OF MEDICINE, BIOLOGICAL SCIENCES AND PSYCHOLOGY/School of Medicine/Department of Cardiovascular Sciences

Version

  • AM (Accepted Manuscript)

Published in

Physiological Measurement

Publisher

IOP Publishing

issn

0967-3334

eissn

1361-6579

Copyright date

2017

Available date

2018-03-23

Publisher version

http://iopscience.iop.org/article/10.1088/1361-6579/aa68c4

Notes

The file associated with this record is under embargo until 12 months after publication, in accordance with the publisher's self-archiving policy. The full text may be available through the publisher links provided above.

Language

en