Key result
Stroke volume variation measured with the intra-aortic balloon pump on standby for one minute accurately predicted fluid responsiveness with an area under the ROC curve of 0.91.
Why the study?
Patients with an implanted intra-aortic balloon pump are typically excluded from using stroke volume variation to guide fluid therapy due to pulse contour artifacts caused by the pump.
Does stroke volume variation predict fluid responsiveness in cardiac surgery patients with an implanted intra-aortic balloon pump?
Observational (n=30)
No
Does stroke volume variation predict fluid responsiveness in cardiac surgery patients with an implanted intra-aortic balloon pump?
Effect estimate: AUC 0.91 (95% CI 0.81-1.0)
p-value: p=0.0002
Stroke volume variation measured during a brief one-minute standby of an intra-aortic balloon pump accurately predicts fluid responsiveness in post-cardiac surgery patients.
May support brief intra-aortic balloon pump standby for stroke volume variation assessment post-cardiac surgery; leaves open prospective validation.
There is a vast body of evidence in favor of individualising fluid therapy using dynamic hemodynamic indices like stroke volume variation (SVV). Patients with implanted intra-aortic balloon pump (IABP) are excluded from this approach because of pulse contour artifacts caused by the pump. The aim of this work is to test whether SVV can be used for fluid responsiveness prediction in these patients. Materials and methods: Patients after cardiac surgery with implanted IABP were included in this study. SVV was measured after placing the IABP on standy mode for one minute. Cardiac output (CO) measurement was obtained via Swan-Ganz catheter before and after a 6 ml/kg fluid challenge. Fluid responsiveness was defined as increase of CO by at least 10%. Results: SVV above 8.5% showed a good correlation with fuid responsiveness. Sensitivity was 95 (95% CI 85 to 100) and specificity 82 (95% CI 72 to 92). SVV had an area under the ROC curve 0.91 (95% CI 0.81 to 1.0) Conclusion: SVV is a good predictor of fluid responsiveness in patients with IABP. SVV should not be excluded as a fluid therapy guide for these patients. Placing the pump on standby for one minute allows obtaining an accurate measurement of this important variable.
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Enev et al. (2021) conducted an observational in Low cardiac output syndrome after cardiac surgery with implanted intra-aortic balloon pump (n=30). Stroke volume variation (SVV) measurement with IABP on standby was evaluated on Fluid responsiveness (increase of cardiac output by ≥10% after a 6 ml/kg fluid challenge) (AUC 0.91, 95% CI 0.81-1.0, p=0.0002). Stroke volume variation measured with the intra-aortic balloon pump on standby for one minute accurately predicted fluid responsiveness with an area under the ROC curve of 0.91.
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