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. 2022 Nov 12;12(11):1859.
doi: 10.3390/life12111859.

Concomitant Intra-Aortic Balloon Pumping Significantly Reduces Left Ventricular Pressure during Central Veno-Arterial Extracorporeal Membrane Oxygenation-Results from a Large Animal Model

Ilija Djordjevic  1 , Oliver Liakopoulos  2 , Mara Elskamp  1 , Johanna Maier-Trauth  3 , Stephen Gerfer  1 , Thomas Mühlbauer  1 , Ingo Slottosch  4 , Elmar Kuhn  1 , Anton Sabashnikov  1 , Pia Rademann  5 , Alexandra Maul  5 , Adnana Paunel-Görgülü  1 , Thorsten Wahlers  1 , Antje Christin Deppe  1
Affiliations

Concomitant Intra-Aortic Balloon Pumping Significantly Reduces Left Ventricular Pressure during Central Veno-Arterial Extracorporeal Membrane Oxygenation-Results from a Large Animal Model

Ilija Djordjevic et al. Life (Basel). .

Abstract

(1) Introduction: Simultaneous ECMO and IABP therapy is frequently used. Haemodynamic changes responsible for the success of the concomitant mechanical circulatory support system approach are rarely investigated. In a large-animal model, we analysed haemodynamic parameters before and during ECMO therapy, comparing central and peripheral ECMO circulation with and without simultaneous IABP support. (2) Methods: Thirty-three female pigs were divided into five groups: (1) SHAM, (2) (peripheral)ECMO(-)IABP, (3) (p)ECMO(+)IABP, (4) (central)ECMO(-)IABP, and (5) (c)ECMO(+)IABP. Pigs were cannulated in accordance with the group and supported with ECMO (±IABP) for 10 h. Systemic haemodynamics, cardiac index (CI), and coronary and carotid artery blood flow were determined before, directly after, and at five and ten hours on extracorporeal support. Systemic inflammation (IL-6; IL-10; TNFα; IFNγ), immune response (NETs; cf-DNA), and endothelial injury (ET-1) were also measured. (3) Results: IABP support during antegrade ECMO circulation led to a significant reduction of left ventricular pressure in comparison to retrograde flow in (p)ECMO(-)IABP and (p)ECMO(+)IABP. Blood flow in the left anterior coronary and carotid artery was not affected by extracorporeal circulation. (4) Conclusions: Concomitant central ECMO and IABP therapy leads to significant reduction of intracavitary cardiac pressure, reduces cardiac work, and might therefore contribute to improved recovery in ECMO patients.

Keywords: ECMO; IABP; cardiogenic shock; left ventricular pressure.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Graphical illustration of the study protocol and investigated groups (TP, time point).
Figure 2
Figure 2
Intraoperative situs with view of catheters and flow probes placed (PAP, pulmonary artery pressure; CoBF, coronoary blood flow; LVP, left ventricular pressure; AoBF, aortic blood flow; RVP, right ventricular pressure).
Figure 3
Figure 3
Presentation of the operating room during an ongoing experimental protocol.
Figure 4
Figure 4
Percentage change of contractility index LVdp/dt (max) before and over 10 h of ECMO treatment.
Figure 5
Figure 5
Fold change in systemic release of inflammatory parameters of all groups after 10 h of ECMO treatment compared to pre-ECMO values (mean ± SD, * p < 0.05 compared to (p)ECMO(-)IABP). (A) Cytokines. Fold change in systemic release of IFNγ, IL-6, IL-10, and TNF-α of all groups after 10 h of ECMO treatment compared to pre-ECMO values. (B) NETs. Fold change in systemic release of NETs (neutrophil extracellular traps) of all groups after 5 h and 10 h of ECMO treatment compared to pre-ECMO values. (C) ET-1. Fold change in systemic release of endothelin-1 of all groups after 10 h of ECMO treatment compared to pre-ECMO values. (D) ROS. Fold change in systemic release of ROS (reactive oxygen species) of all groups after 5 h and 10 h of ECMO treatment compared to pre-ECMO values. cECMO, central extracorporeal membrane oxygenation; pECMO, peripheral extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump.
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