Superior performance of a paraaortic counterpulsation device compared to the intraaortic balloon pump

The purpose of this study was to compare the hemodynamic effectiveness of a 30-ml stroke volume paraaortic counterpulsation device (PACD), presenting the advantages of ease of implantation and driving by a standard intraaortic balloon pump (IABP) console (Datascope 96, Datascope Corp., Montvale, NJ, USA) to that of a 40-ml IABP, in the setting of experimental heart failure. In an acute heart failure model, the IABP was placed in the descending aorta and the PACD in the ascending aorta of eight pigs. Both devices were driven by the same system, and hemodynamic measurements were obtained with and without mechanical assistance. The two pumps significantly reduced the systolic and end-diastolic aortic pressures, but the PACD reduced the latter more effectively (42.6 +/- 18.1% vs 11.0 +/- 9.9%,p = 0.0001). Both pumps provided significant aortic diastolic augmentation, but the counterpulsation wave of the PACD was significantly greater (augmentation of 44.8 +/- 22.2% vs 37.6 +/- 15.6%, p = 0.031). Both lowered the end-diastolic left ventricular pressure with a trend toward PACD superiority (24.2 +/- 13.7% vs 19.7 +/- 13.5%,p = 0.064). It is concluded that the PACD, even with smaller stroke volume, is more effective than the IABP. The simplicity of its implantation, together with the ability of the standard IABP consoles to control its function, make it a promising device for mechanical assistance of the failing heart

Blood platelets and sepsis pathophysiology: A new therapeutic prospect in critical ill patients?

Beyond haemostasis, platelets have emerged as versatile effectors of the immune response. The contribution of platelets in inflammation, tissue integrity and defence against infections has considerably widened the spectrum of their role in health and disease. Here, we propose a narrative review that first describes these new platelet attributes. We then examine their relevance to microcirculatory alterations in multi-organ dysfunction, a major sepsis complication. Rapid progresses that are made on the knowledge of novel platelet functions should improve the understanding of thrombocytopenia, a common condition and a predictor of adverse outcome in sepsis, and may provide potential avenues for management and therapy