Usefulness of Intra-aortic Balloon Pump in Patients With Cardiogenic Shock

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Predictors of survival in cardiogenic shock (CS) treated with intra-aortic balloon pump (IABP) are not clearly understood. In this retrospective study, we sought to evaluate patient characteristics and impact of timing of IABP in treatment of CS. Patients presenting to the Yale New Haven Hospital in CS who received IABP between February 2013 and April 2017 were included in the study. We assessed baseline characteristics and clinical predictors of 30-day mortality. Hundred ninety-three (n = 193) patients were included in this study. Mean age was 68.8 ± 14.5 years. Thirty percent (30%) were women, 38% had cardiac arrest, and left ventricular ejection fraction was 33.7 ± 14.9%. Overall 30-day mortality was 36%. Thirty-day mortality was 24% when IABP was placed within less than 1 hour of onset of CS versus 49% when implanted ≥1 hour after recognition of CS (p = 0.001). Mortality was 18%, 21%, 36%, and 74% for patient requiring 0, 1, 2, and 3 or more inotropes after IABP placement (p < 0.001). In multivariate analysis, advancing age, cardiac arrest on presentation, time to IABP implantation, and number of inotropes needed after IABP implantation predicted 30-day mortality. In the 193 patients, 134 (69.4%) presented with CS from ACS and 59 (30.6%) with CS from non-ACS-related causes. No difference in mortality was noted between the ACS and non-ACS groups 34.3% versus 40.7% (p = 0.39). In conclusion, early use of IABP in CS was associated with significant improvement in 30-day mortality regardless of the etiology of CS. Continued need for significant inotropic support after IABP is associated with worse prognosis and maybe used as an indicator for need to escalate to higher levels of support.