Intra-aortic and Intra-caval Balloon Pump Devices in Experimental Non-traumatic Cardiac Arrest and Cardiopulmonary Resuscitation

Abstract

Intra-aortic balloon pump (IABP) use during CPR has been scarcely studied. Intra-caval balloon pump (ICBP) may decrease backward venous flow during CPR. Mechanical chest compressions (MCC) were initiated after 10 min of cardiac arrest in anesthetized pigs. After 5 min of MCC, IABP (n = 6) or ICBP (n = 6) was initiated. The MCC device and the IABP/ICBP had slightly different frequencies, inducing a progressive peak pressure phase shift. IABP inflation 0.15 s before MCC significantly increased mean arterial pressure (MAP) and carotid blood flow (CBF) compared to inflation 0.10 s after MCC and to MCC only. Coronary perfusion pressure significantly increased with IABP inflation 0.25 s before MCC compared to inflation at MCC. ICBP inflation before MCC significantly increased MAP and CBF compared to inflation after MCC but not compared to MCC only. This shows the potential of IABP in CPR when optimally synchronized with MCC. The effect of timing of intra-aortic balloon pump (IABP) inflation during mechanical chest compressions (MCC) on hemodynamics. Data from12 anesthetized pigs.

Keywords: Cardiopulmonary resuscitation; Counterpulsation; Heart arrest; Hemodynamics.

Fig. 1

Experimental overview depicted by typical systemic arterial pressure (SAP) measurements in an anesthetized pig receiving mechanical chest compressions (MCC) after circulatory arrest (CA) with concurrent intra-aortic balloon pump (IABP). Note that time 0 on the x-axis shows the time for initiation of ventricular fibrillation; the time used for induction of anesthesia and instrumentation (at x < 0) has been cropped for illustration purposes. ICBP: intra-caval balloon pump

Fig. 2

$\mathrm{\Delta }t$ showing the offset in synchronization of IABP/ICBP inflation and MCCs. Typical data are presented and are normalized for illustrative purposes. : IABP/ICBP, : MCC

Fig. 3

MAP (a), CPP (b), and mCBF (c) at baseline (MCC) without concurrent IABP, optimal $\mathrm{\Delta }t$ ($\mathrm{\Delta }{t}_{\mathrm{optimal}}$), and unfavorable $\mathrm{\Delta }t$ ($\mathrm{\Delta }{t}_{\mathrm{unfav}.}$) in anesthetized pigs (n = 6). Bars denote the sample mean. Repeated-measure ANOVA was used to produce p-values. *p < 0.05, **p < 0.01, ***p < 0.001, #p < 0.1

Fig. 4

MAP (a), CPP (b), and mCBF (c) for all $\mathrm{\Delta }t$ during MCC with IABP in anesthetized pigs. Bars and whiskers denote mean values ± SE. Each individual data point is aggregated from 6 animals, with each animal contributing 8–12 samples per $\mathrm{\Delta }t$

Fig. 5

MAP (a) and mCBF (b) at baseline (MCC) without concurrent ICBP, optimal $\mathrm{\Delta }t$ ($\mathrm{\Delta }{t}_{\mathrm{optimal}}$), and least optimal $\mathrm{\Delta }t$ ($\mathrm{\Delta }{t}_{\mathrm{unfav}.}$), in anesthetized pigs. Bars denote the sample mean. Repeated-measure ANOVA was used to produce p-values. #p < 0.1, *p < 0.05

Fig. 6

MAP (a) and mCBF (b) for all $\mathrm{\Delta }t$ during MCC and ICBP in anesthetized pigs. Bars and whiskers denote mean values ± SE. Each individual data point is aggregated from 6 animals, with each animal typically contributing 8–12 samples per $\mathrm{\Delta }t$