Balloon-pump counterpulsation for management of severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage

Andrew F. Ducruet, Felipe C. Albuquerque, R. Webster Crowley, Richard Williamson, James Forseth, Cameron G. McDougall

Research output: Contribution to journalReview article

Abstract

Objective: To evaluate the use of intraaortic balloon pump (IABP) placement to counter severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage (SAH). Methods: From August 2006 to October 2011, eight patients (seven women, mean age 47 years ± 5) with aneurysmal SAH underwent IABP placement. The modified Rankin scale (mRS) was used to assess outcome at discharge and long-term follow-up. Results: Most patients presented in poor Hunt & Hess grade (grade III, 25%; grade IV, 62.5%; grade V, 12.5%). Three patients underwent surgical clipping, and five patients underwent endovascular treatment. All patients had severe cardiogenic shock, with a mean ejection fraction of 21%. One patient (12.5%) experienced transient left leg ischemia attributable to the IABP. No patient deaths occurred. At discharge, one patient was moderately disabled (mRS = 3), two patients were moderately to severely disabled (mRS, 4), and five patients were severely disabled (mRS = 5). The seven patients available for long-term follow-up (mean, 11.25 months) showed substantial functional improvements. Two patients exhibited no significant disability (mRS = 1), two patients exhibited only slight disability (mRS = 2), and 3 patients exhibited moderate to severe disability (mRS = 4). Conclusions: In select patients, particularly young women with poor-grade SAH, balloon-pump counterpulsation may serve as a useful adjunct in the management of severe cardiac dysfunction after SAH. Further investigation is necessary to define the optimal patient population for this technique.

Original languageEnglish (US)
Pages (from-to)e347-e352
JournalWorld neurosurgery
Volume80
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

Keywords

  • Aneurysm
  • Balloon pump
  • Stunned myocardium
  • Subarachnoid hemorrhage
  • Takotsubo
  • Vasospasm

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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