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Effects of intra‐aortic balloon counterpulsation on parameters of tissue oxygenation

Background and objective: To investigate the effects of intra‐aortic balloon pump therapy on parameters of global and regional oxygenation in patients undergoing cardiac surgery. Methods: As part of a large surveillance study in cardiac surgery patients (n = 266) we retrospectively analyzed the course of 28 patients requiring intra‐aortic balloon pump therapy. Patients were grouped according to the time point of pump insertion (during weaning from cardiopulmonary bypass: group early intra‐aortic balloon pumping (n = 17); after admission to the intensive care unit: group late intra‐aortic balloon pumping (n = 9). Haemodynamic and tonometric variables, arterial lactate, and use of catecholamines were measured hourly. Measurements and results: Cardiac index increased in both groups after intra‐aortic balloon pump insertion (2.2 ± 0.5 baseline; 3.4 ± 0.8 L min−1 m−2 4 h later (group early intra‐aortic balloon pumping); 2.8 ± 0.5 baseline, 3.6 ± L min−1 m−2 4 h later (group later intra‐aortic balloon pumping), each P < 0.05), there were no differences between groups. Arterial lactate values increased in group later intra‐aortic balloon pumping after pump insertion to a maximum 2 h later (8.4 ± 6.1 mmol L−1 baseline; 12.7 ± 7.4 mmol L−1, P < 0.05), and decreased continuously afterwards. The difference of arterial and gastric CO2 showed a sharp decrease after pump insertion in group later intra‐aortic balloon pumping (26.4 ± 9.8 baseline; 7.0 ± 11.1 mmHg, P < 0.05). There were no differences between groups. Epinephrine doses were higher in group later intra‐aortic balloon pumping (P < 0.05). Conclusions: Intra‐aortic balloon pump therapy improved global and regional splanchnic oxygenation in cardiac surgery patients with low‐cardiac‐output syndrome. Gastro‐intestinal tonometry could provide additional information concerning tissue oxygenation. Patients with later intra‐aortic balloon pump insertion needed more catecholamine therapy to achieve similar haemodynamic values.