INTRAAORTIC BALLOON PUMP COUNTERPULSATION IN THE MANAGEMENT OF CONCOMITANT CEREBRAL VASOSPASM AND CARDIAC-FAILURE AFTER SUBARACHNOID HEMORRHAGE - TECHNICAL CASE-REPORT

WE REPORT TWO patients who had symptomatic cerebral vasospasm and card iac failure after aneurysmal subarachnoid hemorrhage and who were trea ted successfully with intra-aortic balloon pump counterpulsation thera py. Both patients developed congestive heart failure and pulmonary ede ma while receiving postoperative hypertensive, hypervolemic, hemodilut ional (Triple-H) therapy for symptomatic cerebral vasospasm. Both case s of cardiac failure were refractory to maximum presser and inotropic infusions. Intra-aortic balloon pump counterpulsation was used to opti mize cardiac performance to allow continuation of Triple-H therapy and to maintain adequate cerebral perfusion in an attempt to decrease the risk of cerebral ischemic complications. Both patients have had good long-term outcomes. These two cases illustrate the potential usefulnes s of the intra-aortic balloon pump as an adjunct to Triple-H therapy i n patients with symptomatic cerebral vasospasm and cardiac failure. To our knowledge, this report documents the first clinical application o f this adjunctive therapy for vasospasm after aneurysmal subarachnoid hemorrhage.