• Fabio Silvio Taccone, Boris Lubicz, Michael Piagnerelli, Marc Van Nuffelen, Jean-Louis Vincent, and Daniel De Backer.
• Department of Intensive Care, Erasme University Hospital, Université Libre de Bruxelles, 808, 1070, Brussels, Belgium. ftaccone@ulb.ac.be
• Neurocrit Care. 2009 Jan 1; 10 (1): 76-82.

IntroductionExcessive use of adrenergic agents may result in stunned myocardium.CasesWe report the cases of two patients with subarachnoid hemorrhage (SAH) complicated by cardiogenic shock secondary to triple-H therapy for cerebral vasospasm. Both patients had normal cardiac function on admission and no signs of acute myocardial infarction at the onset of cardiogenic shock. Intra-aortic balloon pump (IABP) counterpulsation was used to maintain adequate cerebral perfusion while enabling the high doses of norepinephrine that were being administered to be reduced. Reversal of the myocardial dysfunction after vasopressors were discontinued supported a diagnosis of catecholamine-induced stunned myocardium.ConclusionIABP counterpulsation may be one therapeutic option for patients with vasospasm after SAH when high doses of vasopressors can induce severe myocardial dysfunction. However, this invasive device may not be sufficient to maintain adequate cerebral perfusion and fatal embolic events can complicate the clinical course.

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