Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial.

Autor: Caldas JR; Department of Anesthesia, University of São Paulo, São Paulo, São Paulo, Brazil.; Universidade de Salvador, UNIFACS, Salvador, Bahia, Brazil.; Critical Care Unit Hospital São Rafael Salvador, Salvador, Brazil.; Escola Bahiana de Medicina e Saude Púbica, Salvador, Brazil., Panerai RB; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Centre, Leicester, UK., Bor-Seng-Shu E; Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil., Ferreira GSR; Department of Cardiopneumology, Universidade de São Paulo, São Paulo, Brazil., Camara L; Department of Anesthesia, University of São Paulo, São Paulo, São Paulo, Brazil., Passos RH; Critical Care Unit Hospital São Rafael Salvador, Salvador, Brazil., Salinet AM; Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil., Azevedo DS; Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil., de-Lima-Oliveira M; Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil., Galas FRBG; Department of Anesthesia, University of São Paulo, São Paulo, São Paulo, Brazil., Fukushima JT; Department of Anesthesia, University of São Paulo, São Paulo, São Paulo, Brazil., Nogueira R; Department of Neurosurgery, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil., Taccone FS; Department of Intensive Care, Hopital Erasme, Brussels, Belgium., Landoni G; Department of Anaesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute and Vita-Salute San Raffaele University of Milan, Milan, Italy., Almeida JP; Department of Anesthesia, University of São Paulo, São Paulo, São Paulo, Brazil., Robinson TG; Department of Cardiovascular Sciences, University of Leicester, Leicester, UK.; NIHR Leicester Biomedical Research Centre, Leicester, UK., Hajjar LA; Department of Cardiopneumology, Universidade de São Paulo, São Paulo, Brazil. ludhmila@usp.br.; Surgical Intensive Care, Heart Institute, University of São Paulo, Av. Dr. Ene´as de Carvalho Aguiar 44, 05403-000, São Paulo, Brazil. ludhmila@usp.br.
Jazyk: angličtina
Zdroj: Annals of intensive care [Ann Intensive Care] 2019 Nov 27; Vol. 9 (1), pp. 130. Date of Electronic Publication: 2019 Nov 27.
DOI: 10.1186/s13613-019-0602-z
Abstrakt: Background: The intra-aortic balloon pump (IABP) is often used in high-risk patients undergoing cardiac surgery to improve coronary perfusion and decrease afterload. The effects of the IABP on cerebral hemodynamics are unknown. We therefore assessed the effect of the IABP on cerebral hemodynamics and on neurological complications in patients undergoing cardiac surgery who were randomized to receive or not receive preoperative IABP in the 'Intra-aortic Balloon Counterpulsation in Patients Undergoing Cardiac Surgery' (IABCS) trial.
Methods: This is a prospectively planned analysis of the previously published IABCS trial. Patients undergoing elective coronary artery bypass surgery with ventricular ejection fraction ≤ 40% or EuroSCORE ≥ 6 received preoperative IABP (n = 90) or no IABP (n = 91). Cerebral blood flow velocity (CBFV) of the middle cerebral artery through transcranial Doppler and blood pressure through Finometer or intra-arterial line were recorded preoperatively (T1) and 24 h (T2) and 7 days after surgery (T3) in patients with preoperative IABP (n = 34) and without IABP (n = 33). Cerebral autoregulation was assessed by the autoregulation index that was estimated from the CBFV response to a step change in blood pressure derived by transfer function analysis. Delirium, stroke and cognitive decline 6 months after surgery were recorded.
Results: There were no differences between the IABP and control patients in the autoregulation index (T1: 5.5 ± 1.9 vs. 5.7 ± 1.7; T2: 4.0 ± 1.9 vs. 4.1 ± 1.6; T3: 5.7 ± 2.0 vs. 5.7 ± 1.6, p = 0.97) or CBFV (T1: 57.3 ± 19.4 vs. 59.3 ± 11.8; T2: 74.0 ± 21.6 vs. 74.7 ± 17.5; T3: 71.1 ± 21.3 vs. 68.1 ± 15.1 cm/s; p = 0.952) at all time points. Groups were not different regarding postoperative rates of delirium (26.5% vs. 24.2%, p = 0.83), stroke (3.0% vs. 2.9%, p = 1.00) or cognitive decline through analysis of the Mini-Mental State Examination (16.7% vs. 40.7%; p = 0.07) and Montreal Cognitive Assessment (79.16% vs. 81.5%; p = 1.00).
Conclusions: The preoperative use of the IABP in high-risk patients undergoing cardiac surgery did not affect cerebral hemodynamics and was not associated with a higher incidence of neurological complications. Trial registration http://www.clinicaltrials.gov (NCT02143544).
Databáze: MEDLINE
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