Intra-aortic balloon pump placement in coronary artery bypass grafting patients by day of admission

Gabriel A Del Carmen,Thoralf M Sundt,Andrea Axtell,David Chang,Amy G Fiedler,Serguei Melnitchouk

doi:10.1186/s13019-020-01259-z

Abstract

IntroductionIntra-Aortic Balloon Pumps (IABPs) can be utilized to provide hemodynamic support in high risk patients awaiting coronary artery bypass grafting (CABG). There are many indications for IABP and institutional practice patterns regarding the placement of IABPs is variable. As a result, the preoperative placement of an IABP in a patient awaiting CABG is not standardized and may vary according to non-clinical factors. We hypothesize that the rate of IABP placement varies by day of the week.MethodsA retrospective cohort analysis of the Office of Statewide Health Planning and Development database from 2006 to 2010 was performed. All patients admitted for CABG were included. Patients who died within 24 h of admission and those who had absolute contraindications to IABP placement were excluded. The primary outcome was preoperative IABP placement versus non-placement. A multivariable logistic regression analysis to identify predictors of IABP placement was performed, adjusting for patient demographics, clinical factors, and system variables.ResultsA total of 46,347 patients underwent CABG, of which 7695 (16.60%) had an IABP placed preoperatively. On unadjusted analysis, IABP rates were significantly higher on weekends versus weekdays (20.83% vs. 15.70%, p < 0.001). On adjusted analysis, patients awaiting CABG were 1.30 times more likely to have an IABP placed on weekends than on weekdays (OR: 1.30, 95% CI 1.20–1.40, p < 0.001).ConclusionThe odds of preoperative IABP placement prior to CABG is significantly increased on weekends compared to weekdays, even when controlling for clinical factors. Further exploration of this phenomenon and its associations are warranted.

Highlights

Intra-Aortic Balloon Pumps (IABPs) can be utilized to provide hemodynamic support in high risk patients awaiting coronary artery bypass grafting (CABG)
Patients awaiting CABG were 1.30 times more likely to have an IABP placed on weekends than on weekdays (OR: 1.30, 95% confidence intervals (CI) 1.20–1.40, p < 0.001)
The odds of preoperative IABP placement prior to CABG is significantly increased on weekends compared to weekdays, even when controlling for clinical factors

Summary

Introduction

Intra-Aortic Balloon Pumps (IABPs) can be utilized to provide hemodynamic support in high risk patients awaiting coronary artery bypass grafting (CABG). An IABP may be placed in patients with concerning “anatomy” such as left main coronary artery stenosis or diffuse disease, despite the absence of clinical symptoms [11] These patients will remain in the intensive care unit with IABP hemodynamic augmentation until they undergo surgical revascularization. While IABP counterpulsion provides hemodynamic support for patients with significant coronary artery disease, there are risks and complications associated with the placement and use of the device. These complications can range in severity from an ischemic lower extremity to the uncommon, yet devastating, complication of thrombosis of the descending thoracic aorta [12]. Because of the known clinical risks associated with the placement of IABPs, it is prudent to reduce medically unnecessary IABPs in order to minimize complications associated with the device, and shorten hospital length of stay

Methods

Results

Discussion

Conclusion