Title

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

Document Type

Article

Abstract

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

Keywords

Aneurysm, Balloon pump, IABP, Intraaortic balloon pump, LV, Left ventricular, Modified Rankin Scale, SAH, Stunned myocardium, Subarachnoid hemorrhage, TCD, Takotsubo, Transcranial Doppler, Vasospasm, mRS

Medical Subject Headings

Adult; Case Management; Counterpulsation (adverse effects, methods); Endovascular Procedures; Female; Follow-Up Studies; Heart Diseases (etiology, therapy); Humans; Intra-Aortic Balloon Pumping (adverse effects, methods); Male; Middle Aged; Prospective Studies; Recovery of Function; Retrospective Studies; Subarachnoid Hemorrhage (complications, surgery); Treatment Outcome; Vasospasm, Intracranial (therapy)

Publication Date

12-1-2013

Publication Title

World neurosurgery

E-ISSN

1878-8769

Volume

80

Issue

6

First Page

e347

Last Page

52

PubMed ID

23022633

Digital Object Identifier (DOI)

10.1016/j.wneu.2012.05.029

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