Intra-aortic Balloon Pump Counterpulsation in the Setting of Subarachnoid Hemorrhage, Cerebral Vasospasm, and Neurogenic Stress Cardiomyopathy. Case Report and Review of the Literature

Overview

Journal Neurocrit Care

Specialty Critical Care

Date 2010 Apr 13

PMID 20383610

Citations 13

Authors

Christos Lazaridis

Gustavo Pradilla

Paul A Nyquist

Rafael J Tamargo

Affiliations

Soon will be listed here.

Abstract

Background: The management of symptomatic cerebral vasospasm after aneurysmal subarachnoid hemorrhage (aSAH) can be often complicated by the presence of stunned myocardium and left ventricular failure. Vasopressors and inotropes are commonly used to optimize mean arterial pressure (MAP) and cerebral perfusion pressure (CPP). Intra-aortic balloon counterpulsation pump (IABP) may be indicated in the management of these patients.

Methods: We report the case of a 55-year-old patient who suffered an aSAH complicated by severe left ventricular failure, who subsequently developed symptomatic cerebral vasospasm. Left ventricular failure precluded traditional hemodynamic augmentation, and IABP was successfully used instead, which allowed for reinstitution of hypertensive hypervolemic therapy and prevented delayed cerebral ischemia.

Results: A review of the literature conducted on symptomatic cerebral vasospasm after aSAH and severe left ventricular failure revealed seven publications describing 14 patients with aSAH treated with an IABP during the period of vasospasm.

Conclusions: Intra-aortic balloon counterpulsation pump (IABP) is used for hemodynamic support of patients in cardiogenic shock and its use in the setting of aSAH, cardiomyopathy, and cerebral vasospasm can be beneficial in preventing delayed ischemic deficits.

Citing Articles

Cardiac Injury After Traumatic Brain Injury: Clinical Consequences and Management.

Coppalini G, Salvagno M, Peluso L, Gouvea Bogossian E, Quispe Cornejo A, Labbe V Neurocrit Care. 2023; 40(2):477-485.

PMID: 37378852 DOI: 10.1007/s12028-023-01777-3.

Neurogenic Stunned Myocardium in Severe Neurological Injury.

Kenigsberg B, Barnett C, Mai J, Chang J Curr Neurol Neurosci Rep. 2019; 19(11):90.

PMID: 31720870 DOI: 10.1007/s11910-019-0999-7.

Reversible stress cardiomyopathy in Guillain-Barré syndrome: a case report.

Gravos A, Destounis A, Katsifa K, Tselioti P, Sakellaridis K, Grammatikopoulou V J Med Case Rep. 2019; 13(1):150.

PMID: 31104633 PMC: 6526600. DOI: 10.1186/s13256-019-2085-9.

Impact of fluid challenge increase in cardiac output on the relationship between systemic and cerebral hemodynamics in severe sepsis compared to brain injury and controls.

Le Dorze M, Huche F, Coelembier C, Rabuel C, Payen D Ann Intensive Care. 2018; 8(1):74.

PMID: 29956057 PMC: 6023801. DOI: 10.1186/s13613-018-0419-1.

Transcranial Doppler Waveforms During Intra-aortic Balloon Pump Counterpulsation for Vasospasm Detection After Subarachnoid Hemorrhage.

Morris N, Manning N, Marshall R, Connolly E, Claassen J, Agarwal S Neurosurgery. 2017; 83(3):416-421.

PMID: 28973669 PMC: 6454792. DOI: 10.1093/neuros/nyx405.

References

Pollick C, Cujec B, Parker S, Tator C . Left ventricular wall motion abnormalities in subarachnoid hemorrhage: an echocardiographic study. J Am Coll Cardiol. 1988; 12(3):600-5. DOI: 10.1016/s0735-1097(88)80044-5. View

Girod J, Messerli A, Zidar F, Tang W, Brener S . Images in cardiovascular medicine. Tako-tsubo--like transient left ventricular dysfunction. Circulation. 2003; 107(18):e120-1. DOI: 10.1161/01.CIR.0000062608.53625.DC. View

Neil-Dwyer G, Walter P, Cruickshank J, Doshi B, OGorman P . Effect of propranolol and phentolamine on myocardial necrosis after subarachnoid haemorrhage. Br Med J. 1978; 2(6143):990-2. PMC: 1607890. DOI: 10.1136/bmj.2.6143.990. View

Montessuit M, Chevalley C, King J, Faidutti B . The use of intra-aortic counterpulsation balloon for the treatment of cerebral vasospasm and edema. Surgery. 2000; 127(2):230-3. DOI: 10.1067/msy.2000.102047. View

GREENHOOT J, REICHENBACH D . Cardiac injury and subarachnoid hemorrhage. A clinical, pathological, and physiological correlation. J Neurosurg. 1969; 30(5):521-31. DOI: 10.3171/jns.1969.30.5.0521. View

Ako J, Honda Y, Fitzgerald P . Tako-tsubo-like left ventricular dysfunction. Circulation. 2003; 108(23):e158. DOI: 10.1161/01.CIR.0000102942.24174.AE. View

Lee V, Connolly H, Fulgham J, Manno E, Brown Jr R, Wijdicks E . Tako-tsubo cardiomyopathy in aneurysmal subarachnoid hemorrhage: an underappreciated ventricular dysfunction. J Neurosurg. 2007; 105(2):264-70. DOI: 10.3171/jns.2006.105.2.264. View

Mayer S, Fink M, Homma S, Sherman D, LiMandri G, Lennihan L . Cardiac injury associated with neurogenic pulmonary edema following subarachnoid hemorrhage. Neurology. 1994; 44(5):815-20. DOI: 10.1212/wnl.44.5.815. View

Kono T, Morita H, Kuroiwa T, Onaka H, Takatsuka H, Fujiwara A . Left ventricular wall motion abnormalities in patients with subarachnoid hemorrhage: neurogenic stunned myocardium. J Am Coll Cardiol. 1994; 24(3):636-40. DOI: 10.1016/0735-1097(94)90008-6. View

10.

Fujita K, Fukuhara T, Munemasa M, Numba Y, Kuyama H . Ampulla cardiomyopathy associated with aneurysmal subarachnoid hemorrhage: report of 6 patients. Surg Neurol. 2007; 68(5):556-61. DOI: 10.1016/j.surneu.2006.11.041. View

11.

Lee V, Oh J, Mulvagh S, Wijdicks E . Mechanisms in neurogenic stress cardiomyopathy after aneurysmal subarachnoid hemorrhage. Neurocrit Care. 2007; 5(3):243-9. DOI: 10.1385/NCC:5:3:243. View

12.

Urban P, Freedman R, Ohman E, Stone G, Christenson J, Cohen M . In-hospital mortality associated with the use of intra-aortic balloon counterpulsation. Am J Cardiol. 2004; 94(2):181-5. DOI: 10.1016/j.amjcard.2004.03.058. View

13.

Nussbaum E, Sebring L, Ganz W, Madison M . Intra-aortic balloon counterpulsation augments cerebral blood flow in the patient with cerebral vasospasm: a xenon-enhanced computed tomography study. Neurosurgery. 1998; 42(1):206-13; discussion 213-4. DOI: 10.1097/00006123-199801000-00048. View

14.

Frontera J, Claassen J, Schmidt J, Wartenberg K, Temes R, Connolly Jr E . Prediction of symptomatic vasospasm after subarachnoid hemorrhage: the modified fisher scale. Neurosurgery. 2006; 59(1):21-7. DOI: 10.1227/01.neu.0000243277.86222.6c. View

15.

Meisel S, Shochat M, Sheikha S, Osipov A, Kogan A, Anabussi N . Utilization of low-profile intra-aortic balloon catheters inserted by the sheathless technique in acute cardiac patients: clinical efficacy with a very low complication rate. Clin Cardiol. 2004; 27(11):600-4. PMC: 6654062. DOI: 10.1002/clc.4960271104. View

16.

SPANN R, LANG D, Birch A, Lamb R, Neil-Dwyer G . Intra-aortic balloon counterpulsation: augmentation of cerebral blood flow after aneurysmal subarachnoid haemorrhage. Acta Neurochir (Wien). 2001; 143(2):115-23. DOI: 10.1007/s007010170115. View

17.

Wittstein I, Thiemann D, Lima J, Baughman K, Schulman S, Gerstenblith G . Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005; 352(6):539-48. DOI: 10.1056/NEJMoa043046. View

18.

. Report of World Federation of Neurological Surgeons Committee on a Universal Subarachnoid Hemorrhage Grading Scale. J Neurosurg. 1988; 68(6):985-6. DOI: 10.3171/jns.1988.68.6.0985. View

19.

Parekh N, Venkatesh B, Cross D, Leditschke A, Atherton J, Miles W . Cardiac troponin I predicts myocardial dysfunction in aneurysmal subarachnoid hemorrhage. J Am Coll Cardiol. 2000; 36(4):1328-35. DOI: 10.1016/s0735-1097(00)00857-3. View

20.

HUNT W, Hess R . Surgical risk as related to time of intervention in the repair of intracranial aneurysms. J Neurosurg. 1968; 28(1):14-20. DOI: 10.3171/jns.1968.28.1.0014. View