Ole K Møller-Helgestad1, Christian B Poulsen2, Evald H Christiansen2, Jens F Lassen2, Hanne B Ravn3. 1. Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Denmark. Electronic address: ole.helgestad@hotmail.com. 2. Department of Cardiology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark. 3. Department of Anaesthesiology & Intensive Care, Aarhus University Hospital, Denmark.
Abstract
BACKGROUND: Cardiogenic shock as a complication to an acute myocardial infarction has an unacceptably high death rate that has not changed for the last 15years. Mortality is partly related to organ hypoperfusion and mechanical assist devices are used for the most severe cases but we do not know which assist device is the best option. Therefore, we have investigated how an IABP and an Impella®-pump influenced blood flow to the brain, heart and kidneys, in a closed-chest porcine model of severe left ventricular failure. METHODS: 13 pigs were anesthetised and left ventricular failure was induced by occluding the proximal LAD for 45min followed by 30min of reperfusion. Blood flow was measured in the carotid artery, the LAD, and the renal artery. The Impella® and IABP were inserted via the femoral arteries, and the two devices were tested individually and combined after induction of heart failure. RESULTS: Carotid- (p=0.01) and renal blood flow (p=0.045) were higher on Impella®-support, compared to no support. None of the devices altered the blood flow in the LAD. Cardiac power output (p<0.005) and left ventricular work (p<0.00) were also higher on Impella®-support compared to no support. CONCLUSION: Haemodynamics and blood flow to the brain and kidneys were significantly better on Impella®-support, suggesting that the Impella® is superior to the IABP in a state of ischaemia induced left ventricular failure. These data, however, needs to be confirmed in a proper clinical trial with patients in cardiogenic shock.
BACKGROUND:Cardiogenic shock as a complication to an acute myocardial infarction has an unacceptably high death rate that has not changed for the last 15years. Mortality is partly related to organ hypoperfusion and mechanical assist devices are used for the most severe cases but we do not know which assist device is the best option. Therefore, we have investigated how an IABP and an Impella®-pump influenced blood flow to the brain, heart and kidneys, in a closed-chest porcine model of severe left ventricular failure. METHODS: 13 pigs were anesthetised and left ventricular failure was induced by occluding the proximal LAD for 45min followed by 30min of reperfusion. Blood flow was measured in the carotid artery, the LAD, and the renal artery. The Impella® and IABP were inserted via the femoral arteries, and the two devices were tested individually and combined after induction of heart failure. RESULTS: Carotid- (p=0.01) and renal blood flow (p=0.045) were higher on Impella®-support, compared to no support. None of the devices altered the blood flow in the LAD. Cardiac power output (p<0.005) and left ventricular work (p<0.00) were also higher on Impella®-support compared to no support. CONCLUSION: Haemodynamics and blood flow to the brain and kidneys were significantly better on Impella®-support, suggesting that the Impella® is superior to the IABP in a state of ischaemia induced left ventricular failure. These data, however, needs to be confirmed in a proper clinical trial with patients in cardiogenic shock.
Authors: Christian Riehle; Jan-Thorben Sieweke; Sayan Bakshi; Chae-Myeong Ha; Nanna Louise Junker Udesen; Ole K Møller-Helgestad; Natali Froese; Hanne Berg Ravn; Heike Bähre; Robert Geffers; Roland Seifert; Jacob E Møller; Adam R Wende; Johann Bauersachs; Andreas Schäfer Journal: Front Cardiovasc Med Date: 2022-05-25
Authors: Johannes Mierke; Thomas Nowack; Tobias Loehn; Franziska Kluge; Frederike Poege; Uwe Speiser; Felix Woitek; Norman Mangner; Karim Ibrahim; Axel Linke; Christian Pfluecke Journal: Int J Cardiol Heart Vasc Date: 2022-03-30
Authors: Ole Kristian Lerche Helgestad; Jakob Josiassen; Christian Hassager; Lisette Okkels Jensen; Lene Holmvang; Nanna Louise Junker Udesen; Henrik Schmidt; Hanne Berg Ravn; Jacob Eifer Moller Journal: Open Heart Date: 2020-03-04