Effect of intra-arterial balloon pumping for refractory septic cardiomyopathy: A case series

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.