Intra-aortic balloon pump in patients with cardiogenic shock complicating myocardial infarction: a systematic review and meta-analysis of randomized trials (protocol)

Sultan Altayyar,Waleed Alhazzani,Sami Alnasser,Bandar Baw,Awad Al‐Omari ,Alison Fox‐Robichaud ,Bram Rochwerg

doi:10.1186/2046-4053-3-24

Abstract

BackgroundCardiogenic shock is the leading cause of death in patients with acute myocardial infarction. Despite significant advancements in health technology and research, hospital mortality approaches 50%. The intra-aortic balloon pump is a mechanical hemodynamic assist device that has been used for over 40 years in the management of patients with cardiogenic shock. A recent randomized trial suggests that the use of intra-aortic balloon pumps does not reduce mortality in patients with ischemic cardiogenic shock.MethodsWe plan to search MEDLINE, EMBASE, and the Cochrane Trial Registry for potentially eligible randomized trials that compare the use of intra-aortic balloon pump with no mechanical device support in patients with cardiogenic shock. No date, language or journal limitations will be applied. Two reviewers will independently screen and identify eligible studies using predefined eligibility criteria. Data abstraction will be done independently and in duplicate. We plan to use RevMan software to generate pooled estimates across included studies, using the previously published method of DerSimonian and Laird. We will report pooled estimates as risk ratios with 95% confidence intervals for binary outcomes, and as mean differences with 95% confidence intervals for continuous outcomes. We will assess the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.DiscussionThe aim of this systematic review and meta-analysis is to summarize the available evidence on the efficacy of the intra-aortic balloon pump in cardiogenic shock.Systematic review registration: PROSPERO CRD42014007056.

Highlights

Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction
Description of the condition Cardiogenic shock occurs as a consequence of cardiac pump failure
Improved hemodynamics using an Intra-aortic balloon pump (IABP) in patients with cardiogenic shock have been reported anecdotally by care providers, with registry-based observational studies [3,4] suggesting potential benefit

Summary

Introduction

Cardiogenic shock is the leading cause of death in patients with acute myocardial infarction. The intra-aortic balloon pump is a mechanical hemodynamic assist device that has been used for over 40 years in the management of patients with cardiogenic shock. A recent randomized trial suggests that the use of intra-aortic balloon pumps does not reduce mortality in patients with ischemic cardiogenic shock. Description of the condition Cardiogenic shock occurs as a consequence of cardiac pump failure. Despite utilization of an early revascularization strategy and advancing health care, cardiogenic shock remains the leading cause of death in this population with a hospital mortality rate approaching 40 to 50% [1,2]. Improved hemodynamics using an IABP in patients with cardiogenic shock have been reported anecdotally by care providers, with registry-based observational studies [3,4] suggesting potential benefit. A recent randomized trial showed no effect on 30-day mortality using an IABP compared with standard of care

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