Balloon Pump In Cardiogenic Shock Research Articles

Clinical management ancillary to phase-shift balloon pumping in cardiogenic shock: Preliminary comments

Intraaortic phase-shift balloon pumping was utilized in 30 patients in cardiogenic shock secondary to acute myocardial infarction who were refractory to conventional pharmacologic therapy. The outcomes in these cases suggested that the interval from myocardial infarction to onset of shock, rather than the duration of shock, may have a significant influence on the prognosis. Of 20 patients classified as having “early” shock, 3 died as a result of factors related to the procedure. Of the remaining 17 patients, the condition of 15 (88 percent) improved to the point that intraaortic balloon pumping could be discontinued. Nine of these patients were long-term survivors. Of 10 patients with delayed onset of shock, the condition of only 4 improved, and none left the hospital alive. Myocardial rupture was proved to have occurred in 5 of these patients, and suspected on clinical grounds in 1 patient. The clinical management essential to successful intraaortic balloon pumping is summarized.

Intraaortic balloon pumping in the experimental animal: Effects and problems

Although the basic principle of intraaortic balloon pumping theoretically appears both sound and simple, the effects of balloon pumping in the experimental animal depend on a number of variables, some related to the animal (functional state of the left ventricle, shifting heart rates and arrhythmias, intraaortic blood volume), some to the balloon (ratio of inflated balloon volume to central aortic volume and stroke volume, relation of balloon inflation/deflation to rate of left ventricular ejection, and timing and duration of application). These factors limit the effectiveness of intraaortic balloon pumping in cardiogenic shock when the need for mechanical circulatory assistance is most acute.

Phase-shift balloon pumping in cardiogenic shock

Twenty-one patients with intractable shock (in 20, secondary to myocardial infarction; in one, probably due to aneurysm-induced left ventricular pump failure) were treated with mechanical circulatory assistance utilizing an intraaortic balloon. In 16 patients circulatory failure developed within 36 hours of the onset of myocardial infarction. Shock was permanently reversed in 13 of these patients, and 5 were well 7 to 18 months after mechanical assistance; 2 long-term survivors died, one 19 months, and the other 7 months, after balloon pumping. In 5 patients in whom the onset of circulatory failure was delayed to 36 hours or more after myocardial infarction, shock was reversed during active mechanical assistance. The limiting factor in 4 of these patients was the natural evolution of the infarct to necrosis and myocardial rupture. In contrast, 18 patients, in whom mechanically assisted circulation was indicated but for various reasons could not be performed, died from shock. On the basis of this limited experience, we believe that mechanical circulatory assistance has a real therapeutic role in the treatment of intractable circulatory failure developing relatively early in the course of acute myocardial infarction. Its efficacy in so-called delayed circulatory failure requires further clarification.

Intraaortic Balloon Pumping

To the Editor:— With reference to our article, Initial Clinical Experience With Intraaortic Balloon Pumping in Cardiogenic Shock, which appeared inThe Journal(203:113, 1968), at the time our addendum regarding three additional patients was submitted, a complete follow-up on the sixth patient was not available. The patient subsequently died seven days after the procedure, from pulmonary complications. His hemodynamic status remained stable until his sudden death from pulmonary and renal complications.

Initial clinical experience with intraaortic balloon pumping in cardiogenic shock

Initial clinical experience with intraaortic balloon pumping in cardiogenic shock