Combined ECMO and IABP support in an acute animal model: Impact of different cannulation strategies on renal blood flow

Objective: The combination of intra- aortic balloon pumping (IABP) and veno- arterial extracorporeal membrane oxygenation (ECMO) in patients with low cardiac output syndrome has been confirmed to improve efficacy of the cardiac support as a whole.

However, the impact of different ECMO cannulation techniques (peripherally via a femoral artery vs. centrally via the ascending aorta) on renal blood flow during concomitant use of IABP remains unclear.

The purpose of this study was to determine the effects of additional IABP support on the degree of renal blood flow with central and with peripheral veno- arterial ECMO by means of direct measurements.

Methods: Renal arterial flow obtained by direct measurement with an intravascular catheter in the left renal artery. Blood Pressure was tabulated during intra aortic balloon pumping with central and with peripheral ECMO support in six pigs. These parameters were evaluated with respect to changes in the ECMO approach.

Results: Mean renal arterial pressure increased as the extracorporeal membrane oxygenation flow was initiated from peripheral in contrast to central ECMO access with continuous IABP support.

Conclusion: In conclusion, IABP with peripheral veno-arterial extracorporeal membrane oxygenation causes better renal artery blood flow in contrast to central cannulation.