Original Article

Diastolic Augmentation with an External Pulsating Device To Treat Cardiogenic Shock

Mercy Hospital, Des Moines, Iowa, 50314

^* From the Section of Cardiovascular Medicine and Surgery, Mercy Hospital, Des Moines, Iowa 50314—Reprint requests to: Nickolas Trubov, 6124 Downey N. E. Albuquerque, New Mexico 87109.

Abstract

An 80 cc stroke volume pulsatile assist device (PAD) was modified and used in place of an intra-aortic balloon for diastolic augmentation when passage of the balloon proved impossible due to aorto-femoral obstruction. The PAD was attached via the usual 10 mm graft sutured end-to-side to the patient’ s left common femoral artery. Systemic heparinization prevented coagulation for 72 hours of PAD support after which time the patient had recovered and was discharged. Metabolic blood pressure was augmented 20–30 mm Hg and CVP reduced from 21 to 9 mm Hg. Pulmonary artery wedge pressure was reduced from 26 to 12 mg Hg and normal urine output was restored. Plasma free hemoglobin ranged from 5–41 mg% and platelet count from 92,000 to 188,000. No complications occurred. Timing was performed in the same manner as in surgery when the PAD is used in conjunction with the pump-oxygenator, and similar precautions were taken. The PAD appears to be an effective alternative counterpulsation in patients suffering from obstructive arteriosclerotic disease precluding the insertion of a balloon catheter.

Intra-aortic balloon pumping is an accepted mode of therapy for treatment of complicated myocardial infarction. ^1,2 Some patients who would benefit from intra-aortic balloon pumping cannot have the procedure applied via the femoral artery because of severe arteriosclerotic occlusive disease. This can prevent passage of the balloon or result in complications of insertion. ^3–5 A small group of patients in which intra-aortic balloon pump can be applied, develop varying degrees of ischemic neuropathy in the leg in which the balloon was inserted, because of subliminal occlusion by the balloon catheter of the femoral artery, reducing flow through that leg. Here we describe a patient in which an intra-aortic balloon could not be inserted and a Pulsatile Assist Device (PAD^®)* was utilized for diastolic augmentation.^6,7