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 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)
JournalWorld Neurosurgery
Volume80
Issue number6
DOIs
StatePublished - Dec 1 2013
Externally publishedYes

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Counterpulsation
Subarachnoid Hemorrhage
Cardiogenic Shock

Keywords

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

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Balloon-pump counterpulsation for management of severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage. / Ducruet, Andrew F.; Albuquerque, Felipe C.; Crowley, R. Webster; Williamson, Richard; Forseth, James; McDougall, Cameron.

In: World Neurosurgery, Vol. 80, No. 6, 01.12.2013.

Research output: Contribution to journalReview article

Ducruet, Andrew F. ; Albuquerque, Felipe C. ; Crowley, R. Webster ; Williamson, Richard ; Forseth, James ; McDougall, Cameron. / Balloon-pump counterpulsation for management of severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage. In: World Neurosurgery. 2013 ; Vol. 80, No. 6.
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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.",
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