Indian Journal of Critical Care Medicine

Register      Login

SEARCH WITHIN CONTENT

FIND ARTICLE

Volume / Issue

Online First

Archive
Related articles

VOLUME 23 , ISSUE 4 ( April, 2019 ) > List of Articles

BRIEF COMMUNICATION

Effect of Intra-arterial Balloon Pumping for Refractory Septic Cardiomyopathy: A Case Series

Yuji Takahashi, Tomohiro Sonoo, Hiromu Naraba, Hideki Hashimoto, Kensuke Nakamura

Keywords : Cardiogenic shock, Critical care, IABP, Sepsis, Septic cardiomyopathy

Citation Information : Takahashi Y, Sonoo T, Naraba H, Hashimoto H, Nakamura K. Effect of Intra-arterial Balloon Pumping for Refractory Septic Cardiomyopathy: A Case Series. Indian J Crit Care Med 2019; 23 (4):182-185.

DOI: 10.5005/jp-journals-10071-23150

License: CC BY-NC 4.0

Published Online: 01-03-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Abstract

Background and aims: Patients with septic cardiomyopathy (SCM) occasionally develop refractory cardiogenic shock, which is difficult to resolve even with the administration of standard dose of catecholamines. Although venoarterial extracorporeal membrane oxygenation (VAECMO) has recently been reported with good treatment results, there have been no evidence-based practices. Furthermore, severe SCM may be fatal if the blood pressure cannot be increased. This case series explored whether the application of intra-arterial balloon pumping (IABP) is an effective method for increasing blood pressure in patients with severe SCM. Subjects and methods: Over a 58-month period, all patients who were admitted in the emergency and critical care center and managed with IABP were investigated. Among these, data sets of patients diagnosed with SCM were evaluated retrospectively. Results: Ten patients were included in this analysis. Their mean APACHE II and SOFA scores were 26.8±7.9 and 13.9±1.7, respectively. A mean arterial pressure (MAP) increase of more than 30% was achieved in six patients, and a decrease in catecholamine index was observed in five. The effective group consisted of seven patients. The stroke volume increased in 83% of patients who were equipped with pulmonary artery or transpulmonary thermodilution catheter. Low heart rate and regular heart rhythm may be important factors for the effectiveness of IABP for cardiogenic shock caused by refractory SCM. Conclusion: Intra-arterial balloon pumping may be able to raise MAP in refractory SCM patients even with septic shock by an increase in cardiac output.


PDF Share
  1. Ehrman RR, Sullivan AN, et al. Pathophysiology, echocardiographic evaluation, biomarker findings, and prognostic implications of septic cardiomyopathy: a review of the literature. Crit Care 2018;22(1):112.
  2. Beesley SJ, Weber G, et al. Septic Cardiomyopathy. Crit Care Med 2018;46(4):625–634.
  3. Angus DC, van der Poll T. Severe sepsis and septic shock. N Engl J Med 2013;369:840–851.
  4. Singer M, Deutschman CS, et al. The third international consensus definitions for sepsis and septic shock (Sepsis-3). JAMA 2016;315:801– 810.
  5. Abraham E, Singer M. Mechanisms of sepsis-induced organ dysfunction. Crit Care Med 2007;35:2408–2416.
  6. Blanco J, Muriel-Bombín A, et al. Incidence, organ dysfunction and mortality in severe sepsis: a Spanish multicentre study. Crit Care 2008;12(6):R158.
  7. Annane D, Vignon P, et al. Norepinephrine plus dobutamine versus epinephrine alone for management of septic shock: a randomized trial. Lancet 2007;370(9588):676–684.
  8. Mahmoud KM, Ammar AS. Norepinephrine supplemented with dobutamine or epinephrine for the cardiovascular support of patients with septic shock. Indian J Crit Care Med 2012;16(2):75–80.
  9. Prabhu SD. Cytokine-induced modulation of cardiac function. Circulation Research 2004;95:1140–1153.
  10. Kakihana Y, Ito T, et al. Sepsis-induced myocardial dysfunction: pathophysiology and management. J Intensive Care 2016;4:22.
  11. Sato R, Nasu M. A review of sepsis-induced cardiomyopathy. J Intensive Care 2015;3:48.
  12. Bréchot N, Luyt CE, et al. Venoarterial extracorporeal membrane oxygenation support for refractory cardiovascular dysfunction during severe bacterial septic shock. Crit Care Med 2013;41(7): 1616–1626.
  13. Nakamura K, Doi K, et al. Endotoxin adsorption by polymyxin B column or intraaortic balloon pumping use for severe septic cardiomyopathy. Am J Emerg Med 2013;31:893.e1-3.
  14. Muller-Werdan U, Buerke M, et al. Septic cardiomyopathy—A not yet discovered cardiomyopathy? Exp Clin Cardiol 2006;11(3):226–236.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.