The human body is a miraculous organism. Multiple organs in the body interact in a manner that gives us life. Each organ fulfills vital roles and, in turn, influences other organs in the overall system. The human brain is no exception; it sends out signals to other parts of the body, not only directly through nerves, but also through chemicals it produces that reach other organs by way of the bloodstream.
This brain-body interaction can be very important to neurosurgeons in their care of patients. And neurosurgeon Dr. E. Sander Connolly is particularly aware of this. As Surgical Director of the Neurointensive Care Unit at Columbia University Medical Center/NewYork-Presbyterian Hospital, Dr. Connolly oversees the treatment of patients who have suffered a severe brain event such as a stroke or hemorrhage. Such patients are monitored for complications affecting not only the brain but also other organs.
The relationship between the nervous (brain) system and the circulatory (heart) system was front and center in a recent study by Dr. Connolly and Columbia neurointerventionalist Dr. Philip Meyers. Dr. Meyers uses state-of-the-art technology to treat blood vessel diseases in the brain. Together they reported on a treatment used in patients with subarachnoid hemorrhage, a type of stroke that involves bleeding into the brain.*
The study, which was published in the Journal of Vascular and Interventional Neurology, focused on a treatment that actually helps the heart as well as the brain in patients with subarachnoid hemorrhage.
What are brain specialists doing looking at the heart? It turns out a patient’s heart is sometimes affected by subarachnoid hemorrhage. The brain, when damaged by stroke, sends out chemicals called catecholamines in response to the stress. And though the reason for this is not completely understood, these catecholamines can damage the heart.
The way a stroke is treated can also lead to stress on the heart. Treatment usually includes medications, known as vasopressors, to raise the blood pressure. Historically these drugs have been needed in order to preserve blood flow to the brain; however, they also cause the heart to work harder and may cause damage to it.
Drs. Connolly and Meyers and their colleagues looked at a way to get around these problems and help the heart. They did this by studying a device known as an intra-aortic balloon pump, or IABP for short.
An IABP is a mechanical device that is designed to help the heart pump blood. It consists of a flexible, narrow tube with a small balloon attached at the end. Doctors insert the tube through a blood vessel, usually in the leg, and advance it so the balloon rests in the aorta—the large vessel at the heart’s exit.
In the aorta, the balloon is set up to inflate and deflate in relation to the heartbeat. When it inflates, it helps pump blood to the rest of the body. When it deflates, it reduces immediate stress on the heart, allowing it to pump better.
In their paper, the authors reported on the use of the IABP in five patients who suffered a subarachnoid hemorrhage. In every case, they found they were able to reduce the amount of vasopressor medication they needed to use. In other words, the pump worked to give the heart a boost and provide good blood flow to the brain without using as much heart-stressing medicine. Complications were rare, and most patients did well in their recovery.
Drs. Connolly and Meyers and their colleagues emphasize that the number of patients in their study was small and that more research is needed. That said, it appears that the intra-aortic balloon pump may be a useful option for some patients suffering a subarachnoid hemorrhage. In addition, the study shows how important it is for doctors who treat these patients to go beyond the brain and look at other parts of the body.
*Full list of authors: Fawaz Al-Mufti, M.D., Nicholas Morris, M.D., Shouri Lahiri, M.D., William Roth, M.D., Jens Witsch, M.D., Iona Machado, B.A., Sachin Agarwal, M.D., Soojin Park, M.D., Philip M. Meyers, M.D., E. Sander Connolly, M.D., and Jan Claassen, M.D., Ph.D.
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