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Baldetti L, Pagnesi M, Gramegna M, Belletti A, Beneduce A, Pazzanese V, Calvo F, Sacchi S, Van Mieghem NM, den Uil CA, Metra M, Cappelletti AM. Intra-Aortic Balloon Pumping in Acute Decompensated Heart Failure With Hypoperfusion: From Pathophysiology to Clinical Practice. Circ Heart Fail 2021; 14:e008527. [PMID: 34706550 DOI: 10.1161/circheartfailure.121.008527] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Trials on intra-aortic balloon pump (IABP) use in cardiogenic shock related to acute myocardial infarction have shown disappointing results. The role of IABP in cardiogenic shock treatment remains unclear, and new (potentially more potent) mechanical circulatory supports with arguably larger device profile are emerging. A reappraisal of the physiological premises of intra-aortic counterpulsation may underpin the rationale to maintain IABP as a valuable therapeutic option for patients with acute decompensated heart failure and tissue hypoperfusion. Several pathophysiological features differ between myocardial infarction- and acute decompensated heart failure-related hypoperfusion, encompassing cardiogenic shock severity, filling status, systemic vascular resistances rise, and adaptation to chronic (if preexisting) left ventricular dysfunction. IABP combines a more substantial effect on left ventricular afterload with a modest increase in cardiac output and would therefore be most suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise. The acute decompensated heart failure syndrome is characterized by exquisite afterload-sensitivity of cardiac output and may be an ideal setting for counterpulsation. Several hemodynamic variables have been shown to predict response to IABP within this scenario, potentially guiding appropriate patient selection. Finally, acute decompensated heart failure with hypoperfusion may frequently represent an end stage in the heart failure history: IABP may provide sufficient hemodynamic support and prompt end-organ function recovery in view of more definitive heart replacement therapies while preserving ambulation when used with a transaxillary approach.
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Affiliation(s)
- Luca Baldetti
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Matteo Pagnesi
- Department of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.P., M.M.)
| | - Mario Gramegna
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Alessandro Belletti
- Cardiac Intensive Care Unit, Department of Anesthesia and Intensive Care (A. Belletti)
| | | | - Vittorio Pazzanese
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Francesco Calvo
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Stefania Sacchi
- IRCCS San Raffaele Scientific Institute, Milan, Italy (L.B., M.G., V.P., F.C., S.S., A.M.C.)
| | - Nicolas M Van Mieghem
- Department of Cardiology and Intensive Care Medicine, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (N.M.V.M., C.A.d.U.)
| | - Corstiaan A den Uil
- Department of Cardiology and Intensive Care Medicine, Thoraxcenter, Erasmus MC, University Medical Center, Rotterdam, the Netherlands (N.M.V.M., C.A.d.U.).,Department of Intensive Care Medicine, Maasstad Hospital, Rotterdam, the Netherlands (C.A.d.U.)
| | - Marco Metra
- Department of Cardiology, ASST Spedali Civili and Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, Italy (M.P., M.M.)
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Macapagal FR, Bonuel R, Rodriguez H, Mcclellan E. Experiences of Patients Using a Fitness Tracker to Promote Ambulation Before a Heart Transplant. Crit Care Nurse 2021; 41:e19-e27. [PMID: 34333611 DOI: 10.4037/ccn2021516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
BACKGROUND Patients who have an intra-aortic balloon pump or a pulmonary artery catheter with vasoactive infusion while awaiting heart transplant have reduced mobility due to heart failure and activity restrictions. Stroke volume, respiratory capacity, and muscle strength decrease, and sleep disturbances occur. Patients require motivation to enhance ambulation. OBJECTIVE To explore patients' experiences with a fitness tracker to promote ambulation before heart transplant. METHODS In 2017, a fitness tracker was issued to 43 patients before heart transplant who met the study criteria, which included orders to ambulate. Semistructured interviews were conducted after 2 weeks of fitness tracker use with 8 random participants, who were followed up to enhance the credibility of and validate the findings. Responses were interpreted by using descriptive phenomenology and purposive sampling. An expert in phenomenology examined the transcript interpretations and attested that the findings were supported by the data and were internally coherent. The Colaizzi method was used to analyze data. RESULTS A total of 361 significant statements were identified during the participants' interviews and yielded 224 formulated meanings and 16 themes. Themes were categorized into 4 clusters: happy/delighted, motivator, beneficial, and future potential. CONCLUSIONS Participants were happy to get a fitness tracker and motivated to be active and increase activity/ambulation. Patients expressed benefits from walks: better sleep, more stamina, and feeling stronger. They believed that this intervention could have potential benefit for future patients.
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Affiliation(s)
- Frederick R Macapagal
- Frederick R. Macapagal is a registered nurse 3 in the cardiac intensive care unit, DeBakey Heart and Vascular Center, Houston Methodist Hospital, Houston, Texas
| | - Rizalina Bonuel
- Rizalina Bonuel is the system director, nursing practice, Harris Health System, Houston, Texas, and faculty, Pulmonary Critical Care Section, Baylor College of Medicine, Houston, Texas
| | - Holly Rodriguez
- Holly Rodriguez is a registered nurse 3 and unit educator in the cardiac intensive care unit, DeBakey Heart and Vascular Center
| | - Emma Mcclellan
- Emma Mcclellan is the nursing director of the cardiac intensive care unit, DeBakey Heart and Vascular Center
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Aranda JAS, Bavaresco RS, de Carvalho JV, Yamin AC, Tavares MC, Barbosa JLV. A computational model for adaptive recording of vital signs through context histories. JOURNAL OF AMBIENT INTELLIGENCE AND HUMANIZED COMPUTING 2021; 14:1-15. [PMID: 33758628 PMCID: PMC7972018 DOI: 10.1007/s12652-021-03126-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 03/05/2021] [Indexed: 05/06/2023]
Abstract
Wearable devices emerged from the advancement of communication technology and the miniaturization of electronic components. These devices periodically monitor the user's vital signs and generally have a short battery life. This work introduces ODIN, a model for optimized vital signs collection based on adaptive rules. Analyzing vital sign values requires preciseness, so the adaption of these collected data allows a personalized analysis of the user's health condition. The comparison with related works indicates that ODIN is the only model that presents context-aware-adaptive vital signs collection. The implementation of a prototype allowed to perform three evaluations of ODIN. The first evaluation used simulations in different scenarios, with the adaptive approach increasing battery life by 119% through the analysis of input data compared to data collection without adaptivity. The second evaluation applied the prototype to a database of real physiologic data, which allowed reduced data collection when the user has regular vital signs. This reduction optimized battery consumption by 66% compared to collection without adaptivity. Finally, the third evaluation applied ODIN through an Arduino and a heart rate monitor (Polar H7). The average power saved across mobile devices was 21%. Consequently, the adaptive strategy presented in this work allows the optimization of computational resources during the collection and analysis of vital signs. This optimization occurs because of the reduction in energy expenditure and the reduction in the amount of data that needs to be collected and stored.
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Bhimaraj A, Agrawal T, Duran A, Tamimi O, Amione-Guerra J, Trachtenberg B, Guha A, Hussain I, Kim J, Kassi M, Xu J, Suarez E, Ngo UQ, Torre-Amione G, Estep JD. Percutaneous Left Axillary Artery Placement of Intra-Aortic Balloon Pump in Advanced Heart Failure Patients. JACC-HEART FAILURE 2020; 8:313-323. [PMID: 32241538 DOI: 10.1016/j.jchf.2020.01.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Revised: 01/28/2020] [Accepted: 01/28/2020] [Indexed: 11/15/2022]
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