A Retrospective Analysis of the Effects of Concomitant Use of Intra-Aortic Balloon Pump (IABP) and Veno-Arterial Extracorporeal Membrane Oxygenation (va-ECMO) Therapy on Procedural Brain Infarction.

IF 3 3区 医学 Q1 MEDICINE, GENERAL & INTERNAL
Farid Ziayee, Hannan Dalyanoglu, Christian Schnitzler, Kai Jannusch, Matthias Boschheidgen, Judith Boeven, Hug Aubin, Bernd Turowski, Marius Georg Kaschner, Christian Mathys
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引用次数: 0

Abstract

Background/Objectives: Brain ischemia is a frequent complication in patients undergoing veno-arterial extracorporeal membrane oxygenation (va-ECMO) therapy due to hypoperfusion, low oxygenation, and thromboembolism. While concomitant intra-aortic balloon pump (IABP) therapy may improve the perfusion of the supra-aortic branches, it may also favor thromboembolism. This retrospective study aimed to evaluate the effects of combined va-ECMO and IABP therapy on procedural brain infarction compared to va-ECMO therapy alone, with a specific focus on analyzing the types of infarctions. Methods: Cranial computed tomography (CCT) scans of consecutive patients receiving va-ECMO therapy were analyzed retrospectively. Subgroups were formed for patients with combined therapy (ECMO and IABP) and va-ECMO therapy only. The types of infarctions and the potential impacts of va-ECMO vs. combined therapy with IABP on stroke were investigated. Results: Overall, 146 patients (36 female, 110 male, mean age 61 ± 13.3 years) were included, with 69 undergoing combined therapy and 77 patients receiving va-ECMO therapy alone. In total, 14 stroke events occurred in 11 patients in the ECMO-only group and there were 12 events in 12 patients in the ECMO + IABP-group, showing no significant difference (p = 0.61). The majority of infarctions were of thromboembolic (n = 23; 88%) origin, with 14 stroke-events in 12 patients in the ECMO + IABP-group and 9 stroke events in the ECMO-only group. The survival rate within 30 days of treatment was 29% in the ECMO-only group and 32% in the ECMO + IABP group. Conclusions: The results of this retrospective study show that concomitant IABP therapy appears to be neither protective nor more hazardous in relation to ECMO-related stroke. Thus, the indication for additional IABP therapy should be assessed independently from the procedural risk of brain ischemia. Thromboembolic infarctions seem to represent the most common type of infarction in ECMO, especially within the first 48 h of treatment.

主动脉内球囊泵联合静脉-动脉体外膜氧合(va-ECMO)治疗程序性脑梗死的回顾性分析
背景/目的:脑缺血是接受静脉-动脉体外膜氧合(va-ECMO)治疗的患者常见的并发症,原因是低灌注、低氧合和血栓栓塞。虽然伴随的主动脉内球囊泵(IABP)治疗可以改善主动脉上分支的灌注,但它也可能有利于血栓栓塞。本回顾性研究旨在评估联合va-ECMO和IABP治疗与单独va-ECMO治疗相比对程序性脑梗死的影响,并特别关注分析梗死的类型。方法:回顾性分析连续接受va-ECMO治疗患者的颅脑ct (CCT)扫描结果。对联合治疗(ECMO和IABP)和仅采用va-ECMO治疗的患者进行亚组研究。研究了脑梗死的类型以及va-ECMO与IABP联合治疗对脑卒中的潜在影响。结果:共纳入146例患者(女性36例,男性110例,平均年龄61±13.3岁),其中69例接受联合治疗,77例单独接受va-ECMO治疗。仅ECMO组11例患者发生14例卒中事件,ECMO + iabp组12例患者发生12例卒中事件,差异无统计学意义(p = 0.61)。大多数梗死为血栓栓塞性(n = 23;88%), ECMO + iabp组12例患者中有14例卒中事件,仅ECMO组有9例卒中事件。单纯ECMO组30天内生存率为29%,ECMO + IABP组为32%。结论:这项回顾性研究的结果表明,与ecmo相关的卒中相关的IABP治疗似乎既没有保护作用,也没有更大的危险。因此,额外IABP治疗的适应症应独立于脑缺血的程序性风险来评估。血栓栓塞性梗死似乎是ECMO中最常见的梗死类型,尤其是在治疗的前48小时内。
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来源期刊
Diagnostics
Diagnostics Biochemistry, Genetics and Molecular Biology-Clinical Biochemistry
CiteScore
4.70
自引率
8.30%
发文量
2699
审稿时长
19.64 days
期刊介绍: Diagnostics (ISSN 2075-4418) is an international scholarly open access journal on medical diagnostics. It publishes original research articles, reviews, communications and short notes on the research and development of medical diagnostics. There is no restriction on the length of the papers. Our aim is to encourage scientists to publish their experimental and theoretical research in as much detail as possible. Full experimental and/or methodological details must be provided for research articles.
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