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IABP in C ardiogenic S hock

IABP in C ardiogenic S hock. SCHURTZ Guillaume Unité de Soins Intensifs Cardiologiques (USIC) CHRU Lille. Un pronostic qui reste grave malgré reperfusion…. Werdan , K. et al . Mechanical circulatory support in cardiogenic shock . EHJ (2014).

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IABP in C ardiogenic S hock

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  1. IABP in CardiogenicShock SCHURTZ Guillaume Unité de Soins Intensifs Cardiologiques (USIC) CHRU Lille

  2. Un pronostic qui reste grave malgré reperfusion… Werdan, K. et al. Mechanicalcirculatory support in cardiogenicshock. EHJ (2014).

  3. Westaby, S. Cardiogenicshock in ACS. Nat. Rev. Cardiol. (2012)

  4. Physiopathologie Werdan, K. et al. Mechanicalcirculatory support in cardiogenicshock. EHJ (2014).

  5. MR : 10% Septal rupture : 0.5% Free Wall rupture : 3%

  6. Inotropes Francis, G. et al. Inotropes. JACC (2014)

  7. IABP, IMPELLA, TandemHeart Veno-arterial ECMO Westaby, S. Cardiogenicshock in ACS. Nat. Rev. Cardiol. (2012)

  8. IABP : concepts • Inflation en diastole et déflation en systole = augmentation pression diastolique et de perfusion coronaire, réduction post-charge • Débit cardiaque 1L/min • Réduction pré-charge, LVEDP,PWCP • Réduction wall stress, conso 02 -choc cardiogénique -IDM à haut risque -CCV, arythmies ventriculaires…

  9. Hémodynamique Werdan, K. et al. Mechanicalcirculatory support in cardiogenicshock. EHJ (2014).

  10. IABP-SHOCK II • Caractéristiques de la population • Age moyen 70 • Diabète 1/3 • Coronarien 1/4 Thiele, H. et al. Intraaorticballoon support for MocardialInfarctionwithCardiogenicShock. NEJM (2013)

  11. IABP SHOCK II Caractéristiques de la population (2) Thiele, H. et al. Intraaorticballoon support for MocardialInfarctionwithCardiogenicShock. NEJM (2013)

  12. Endpoints à 30J Mortalité toute cause: NS Autres critères: NS Thiele, H. et al. Intraaorticballoon support for MocardialInfarctionwithCardiogenicShock. NEJM (2013)

  13. M12 Absence de bénéfice significatif sur tous les critères à 1an Thiele, H. et al. Intra-aorticballooncounterpulsation in acute myocardialinfarctioncomplicated by cardiogenicshock (IABP-SHOCK II): final 12 monthresults of a randomised, open-label trial. Lancet (2014)

  14. Conclusion • Absence de bénéfice clairement démontré dans le choc cardiogénique post-MI • « Timing » de la pose: incertain… • Problématique du choix de la thérapeutique alternative: ECMO? IMPELLA? • Facilité de pose, absence de bénéfice clair d’autres techniques (peu accessibles+++) • Propre expérience personnelle…

  15. Merci de votre attention!!

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