Balloon Pump In Patients Research Articles

Balón de contrapulsación: ¿ha llegado el momento de su jubilación?

El balón de contrapulsación intraaórtico es el dispositivo de soporte ventricular más utilizado en los últimos 40 años. Sus principales indicaciones son el shock cardiogénico, el infarto agudo de miocardio y asistencia al intervencionismo coronario percutáneo de alto riesgo. La evidencia científica que respalda dicha práctica es escasa. Estudios previos habían indicado que el beneficio de la contrapulsación intraaórtica en el shock se limitaba a los pacientes no reperfundidos o a los sometidos a fibrinolisis, mientras que en los pacientes sometidos a intervencionismo coronario percutáneo primario, tanto sus beneficios hemodinámicos como su impacto clínico parecían atenuarse. Recientemente, los datos del ensayo IABP-shock-II han modificado sensiblemente la recomendación del balón de contrapulsación para pacientes con shock , y se desaconseja su utilización sistemática en este escenario. En este artículo se revisa la principal evidencia sobre el uso del balón de contrapulsación en sus diferentes indicaciones. La amplia experiencia sobre el beneficio clínico y hemodinámico en numerosos pacientes en la práctica clínica cotidiana hace especialmente importante progresar en la definición del escenario idóneo para su utilización; son situaciones potencialmente favorables el paciente con deterioro hemodinámico en sus fases más incipientes o el paciente inestable con lesiones coronarias residuales en los que se planea una revascularización en segundo tiempo. The intra-aortic balloon pump has been the most commonly used ventricular assist device for the last 40 years. Its main indications are cardiogenic shock, acute myocardial infarction and the support of patients undergoing high-risk percutaneous coronary interventions. However, scientific evidence supporting this practice is scarce. Previous studies suggest that the benefits of the intra-aortic balloon pump in patients with cardiogenic shock is limited to patients who have not undergone reperfusion and to those who have received thrombolysis, whereas, in those undergoing primary percutaneous coronary interventions, both the hemodynamic and clinical benefits appear to be small. Recently, the findings of the IABP–SHOCK II trial have markedly changed recommendations on the use of the intra-aortic balloon pump in patients with shock, and its routine use in this context is now discouraged. This article contains a review of the main evidence available on the use of the intra-aortic balloon pump for its different indications. Broad experience of the clinical and hemodynamic benefits of the technique in a large number of patients in routine clinical practice is particularly important for determining where best it can be used: patients in the early stages of hemodynamic deterioration and those with unstable, residual coronary lesions scheduled for a second revascularization could be particularly promising candidates.

Preventive use of intra-aortic balloon pump in patients undergoing high-risk coronary artery bypass grafting: a retrospective study.

BackgroundCoronary artery bypass grafting (CABG) is an important therapeutic measure for CHD patients. The patients who score more than 12 EuroSCORE points cannot achieve good results because of their low cardiac output and delicate left ventricular function. Therefore, use of an intra-aortic balloon pump (IABP) is essential for coronary surgical patients in the peri-operative period. At present, there is no unified standard about when to insert an IABP. This study aimed to compare the short-term clinical outcomes of the IABP inserted in the preoperative condition with its use in the emergency condition for extremely high-risk patients.Material/MethodsIABP support time, respirator support time, and ICU stay time were significantly shorter (all p<0.05) in the preoperative IABP group compared to the emergency IABP group, and the rates of low cardiac output syndrome (LCOS), acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower in the preoperative IABP group (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between two groups.ResultsCompared to the emergency IABP group, the IABP support time, respirator support time and ICU stay time were significantly lower in the preoperative IABP group (all p<0.05), and the rates of LCOS, acute myocardial infarction, and acute kidney injury in the preoperative group were also significantly lower (all p<0.05). There were no significant differences in IABP-related complications and the mortality (p=0.106) between the 2 groups.ConclusionsFor high-risk patients with CABG, preoperative IABP insertion is a safe and effective measure.

Intra-aortic balloon pump for high-risk percutaneous coronary intervention.

The intra-aortic balloon pump (IABP) was first introduced into clinical practice in 1968.1 Early experimental and clinical trials suggested that intra-aortic balloon counterpulsation could provide circulatory assistance to a failing left ventricle.2,3 Counterpulsation—balloon inflation during diastole and deflation in systole—augments the intrinsic Windkessel effect, whereby potential energy stored in the aortic root during systole is converted to kinetic energy with the elastic recoil of the aortic root. Counterpulsation leads to a decline in afterload, a reduction in cardiac work, and therefore myocardial oxygen requirements of the ventricle. Augmentation of diastolic pressure when the balloon is fully inflated together with reduction in left ventricular (LV) filling pressures contribute to improved coronary perfusion (Figures 1 and 2).4 This proposed improvement in myocardial energetics has been further supported by a significant reduction in systemic lactate.5 These physiological enhancements are thought to be of particular benefit after acute myocardial infarction (AMI), supported by animal studies, which have shown a reduction in infarct size when counterpulsation is used.6,7 Figure 1. Coronary perfusion. Coronary flow is predominantly diastolic and further enhanced by counterpulsation, which augments diastolic blood flow and thus coronary perfusion. In addition, aortic recoil during diastole further improves efficiency of the left ventricle. Figure 2. Systemic arterial pressure waveform on introduction of intra-aortic balloon pump–assisted diastolic augmentation. The intra-aortic balloon pump inflates at the dicrotic notch, leading to peak-augmented diastolic pressure. As the balloon deflates, assisted end diastolic pressure is seen to be lower than unassisted end diastolic pressure and assisted systolic pressure is lower than unassisted systolic pressure. Peak diastolic augmentation should be greater than the unassisted systolic pressure and both assisted pressures should be less than the unassisted pressures. Intra-aortic balloon counterpulsation was initially used as a means of supporting patients undergoing surgical revascularization. Percutaneous delivery …

Comparison of the Use of Hemodynamic Support in Patients ≥80 Years Versus Patients

The outcomes of hemodynamic support during high-risk percutaneous coronary intervention in the very elderly are unknown. We sought to compare outcomes between the patients ≥80years versus patients <80years enrolled in the PROTECT II (Prospective Randomized Clinical Trial of Hemodynamic Support with the Impella 2.5 versus Intra-Aortic Balloon Pump in Patients undergoing High Risk Percutaneous Coronary Intervention) randomized trial. Patients who underwent high-risk percutaneous coronary intervention with an unprotected left main or last patent conduit and a left ventricular ejection fraction ≤35% or with 3-vessel disease and a left ventricular ejection fraction ≤30% were randomized to receive an intra-aortic balloon pump or the Impella 2.5; 90-day (or the longest follow-up) outcomes were compared between patients ≥80years (n= 59) and patients <80years (n= 368). At 90 days, the composite end point of major adverse events and major adverse cerebral and cardiac events were similar between patients ≥80 and <80years (45.6% vs 44.1%, p= 0.823, and 23.7% vs 26.8%, p= 0.622, respectively). There were no differences in death, stroke, or myocardial infarction rates between the 2 groups, but fewer repeat revascularization procedures were required in patients ≥80years (1.7% vs 10.4%, p= 0.032). Bleeding and vascular complication rates were low and comparable between the 2 age groups (3.4% vs 2.4%, p= 0.671, and 6.8% vs 5.4%, p= 0.677, respectively). Multivariate analysis confirmed that age was not an independent predictor of major adverse events (odds ratio= 1.031, 95% confidence interval 0.459-2.315, p= 0.941), whereas Impella 2.5 was an independent predictor for improved outcomes irrespective of age (odds ratio= 0.601, 95% confidence interval 0.391-0.923, p= 0.020). In conclusion, the use of percutaneous circulatory support is reasonable and feasible in a selected octogenarian population with similar outcomes as those of younger selected patients. Irrespective of age, the use of Impella 2.5 was an independent predictor of favorable outcomes.

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

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.

Evaluating the learning curve in the prospective Randomized Clinical Trial of hemodynamic support with Impella 2.5 versus Intra-Aortic Balloon Pump in patients undergoing high-risk percutaneous coronary intervention: a prespecified subanalysis of the PROTECT II study

The introduction of new medical devices may be accompanied by a learning curve. To evaluate the impact of the device learning curve on the outcomes of PROTECT II trial, comparing Impella 2.5 versus the intra-aortic balloon pump (IABP) during high-risk percutaneous coronary intervention, we report on a prespecified analysis, excluding the first Impella 2.5 and IABP patients at each site. A total of 448 patients were enrolled at 74 sites. Among these, 58 patients were the first to receive Impella 2.5 at their site, 62 were the first to receive IABP. A trend toward higher major adverse events (MAEs) at 30 days was observed for the subgroup of first versus remaining Impella 2.5 patients: 44.8% versus 31.7%, P = .072. MAE rates for the first and remaining IABP patients were similar at 30 days. After exclusion of the first patient in each group, MAE rates for Impella 2.5 and IABP were 31.7% versus 40.0% (P = .119) at 30 days and 38.0% versus 50.0% (P = .029) at 90 days. Significantly lower 90-day MAE rates were observed with the use of Impella 2.5 compared to the use of IABP after excluding the first patient per group at each site. This prespecified analysis suggests a learning curve associated with initial introduction of the Impella 2.5. Clinical trials should better address the training aspect of new devices, especially when compared with more established devices.

Prophylactic use of a preoperative intra-aortic balloon pump in patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting

Objective The aim of this work was to study the effectiveness of preoperative intra-aortic balloon pump (IABP) in patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting (CABG). Materials and methods We studied 80 consecutive patients of both sexes undergoing elective on-pump CABG having an ejection fraction less than 30%. Thirty patients received preoperative IABP support prophylactically, whereas 50 patients did not. The decision to put an IABP was made by the individual surgeon operating the patient. Preoperative, intraoperative, and postoperative variables were recorded and 30 days' follow-up was obtained. Results were subjected to statistical analysis. Results Fifty one patients (63.7%) were male while 29 (36.25%) were female with a mean age of 55.62 ΁ 9.65 years. Patients who received preoperative IABP had high in-hospital mortality (P = 0.002) and decreased rate of postoperative acute kidney injury (P = 0.048), ICU stay (P = 0.031) and less requirement for postoperative inotropic support (P = 0.047) compared to those who did not receive IABP preoperatively. ConclusionThe prophylactic use of IABP in patients with a low ejection fraction undergoing CABG does not decrease the mortality, but it has a favorable effect on postoperative major complications.

Intra-aortic balloon pump treatment for patients with acute anterior wall myocardial infarction after reperfusion therapy.

We evaluated the effects of an intra-aortic balloon pump on hemodynamics, brain natriuretic peptide concentration and cardiac function of patients with acute myocardial infarction, after reperfusion therapy. Sixty-three patients with acute anterior wall ST-elevation myocardial infarction who underwent primary percutaneous coronary intervention were given an intra-aortic balloon pump (32 cases) or not (control group, 31 cases). The mean pulmonary arterial pressure, pulmonary capillary wedge pressure and cardiac index were measured with a Swan-Ganz catheter. The brain natriuretic peptide concentration was detected by immunochemiluminometric assay. Left ventricular end-diastolic diameter and left ventricular ejection fraction were measured by echocardiography. No difference in baseline was observed between the two groups on day 1 in the hospital. On day 5, mean pulmonary artery pressure and pulmonary capillary wedge pressure of patients with the intra-aortic balloon pump were significantly lower, and cardiac index of was higher than that of the controls, whereas no differences in left ventricular end-diastolic diameter or left ventricular ejection fraction were observed between the two groups. On days 5 and 90, the brain natriuretic peptide concentration of the intra-aortic balloon pump patients was lower than that of the controls. On day 90, left ventricular end-diastolic diameter was smaller in the intra-aortic balloon pump patients, but no difference in left ventricular ejection fraction was observed between the two groups. The intra-aortic balloon pump improved the hemodynamic index and cardiac function and decreased brain natriuretic peptide concentration in patients with acute anterior wall ST-elevation myocardial infarction.

Invited Commentary

Lemaire and colleagues [1Lemaire A. Anderson M.B. Lee L.Y. et al.The Impella device for acute mechanical circulatory support in patients in cardiogenic shock.Ann Thorac Surg. 2014; 97: 133-138Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar] report their experience with the Impella (Abiomed Inc, Danvers, MA) microaxial-flow left ventricular assist device (LVAD) in the setting of cardiogenic shock. The authors reported successful removal of the device in 34 of 47 patients (72%), with only 4 patients requiring transition to long-term LVAD support. The 30-day, 90-day, and 1-year survival was 72%, 66%, and 64%, respectively. The historical context of this report is noteworthy. Minimally invasive mechanical circulatory assist began in the 1960s with the intraaortic balloon pump (IABP) [2Kantrowitz A. Tjonneland S. Freed P.S. et al.Initial clinical experience with intra-aorta balloon pumping in cardiogenic shock.JAMA. 1968; 203: 113-118Crossref PubMed Scopus (585) Google Scholar] and in the 1970s with the Hemopump (Medtronic Inc, Minneapolis, MN). In 1989 Frazier and colleagues [3Frazier O.H. Nakatani T. Duncan J.M. et al.Clinical experience with the Hemopump.ASAIO Trans. 1989; 35: 604-606Crossref PubMed Google Scholar] reported the use of the Hemopump in 12 patients: 6 of the 12 survived 30 days. Although the Hemopump is no longer used, the template of a minimally invasive LVAD was forged. Preceding this study, other multicenter trials validated Impella use in high-risk percutaneous coronary intervention (ie, A Prospective, Multi-center, Randomized Controlled Trial of the IMPELLA RECOVER LP 2.5 System Versus Intra Aortic Balloon Pump [IABP] in Patients Undergoing Non Emergent High Risk PCI [PROTECT II]) and in postcardiotomy shock (ie, IMPELLA® RECOVER® LP/LD 5.0 Support System: A Clinical Safety and Feasibility Study [RECOVER I] [4O'Neill W.W. Kleiman N.S. Moses J. et al.A prospective randomized clinical trial of hemodynamic support of Impella 2.5 versus intra aortic balloon pump in patients undergoing high risk percutaneous coronary intervention: the PROTECT II Study.Circulation. 2012; 126: 1717-1727Crossref PubMed Scopus (531) Google Scholar, 5Griffith B.P. Anderson M.B. Samuels L.E. et al.The RECOVER I: a multicenter prospective study of Impella 5.0/LD for postcardiotomy circulatory support.J Thorac Cardiovasc Surg. 2013; 145: 548-554Abstract Full Text Full Text PDF PubMed Scopus (141) Google Scholar]. A continental registry (ie, EUROSHOCK Registry) tracks outcomes of acute myocardial infarction patients supported with the Impella 2.5; a recent report of 120 patients demonstrated a 64.2% 30-day mortality rate, with survival at 317 ± 526 days reported at only 28.3% [6Lauten A. Engström A.E. Jung C. Empen K. et al.Percutaneous left-ventricular support with the Impella-2.5-assist device in acute cardiogenic shock: results of the Impella-EUROSHOCK-registry.Circ Heart Fail. 2013; 6: 23-30Crossref PubMed Scopus (237) Google Scholar]. Clearly, there is room for improvement. In summary, the disease states that lead to acute cardiogenic shock have not changed in the past 50 years, but the technology to combat it has. The use of multiple and escalating doses of high-dose inotropes to treat low cardiac output is associated with unacceptable mortality and should be abandoned and replaced by mechanical circulatory support [7Samuels L.E. Kaufman M.S. Morris R.J. Pharmacologic criteria for ventricular assist device insertion: experience with the Abiomed BVS 5000 system.J Card Surg. 1999; 14: 288-293Crossref PubMed Scopus (119) Google Scholar]. The experience reported by Lemaire and colleagues [1Lemaire A. Anderson M.B. Lee L.Y. et al.The Impella device for acute mechanical circulatory support in patients in cardiogenic shock.Ann Thorac Surg. 2014; 97: 133-138Abstract Full Text Full Text PDF PubMed Scopus (91) Google Scholar] is noteworthy and commendable. Impella technology and minimally invasive products like it are transforming the landscape of surgical and interventional treatment of this deadly condition. The Impella Device for Acute Mechanical Circulatory Support in Patients in Cardiogenic ShockThe Annals of Thoracic SurgeryVol. 97Issue 1PreviewAcute cardiogenic shock is associated with high mortality rates. Mechanical circulatory devices have been increasingly used in this setting for hemodynamic support. The Impella device (Abiomed Inc, Danvers, MA) is a microaxial left ventricular assist device that can be inserted using a less invasive technique. This study was conducted to determine the outcome of patients who have undergone placement of the Impella device for acute cardiogenic shock in our institution. Full-Text PDF

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Early application of an intra-aortic balloon pump in patients with ST-segment elevation acute myocardial infarction scheduled for elective percutaneous coronary intervention

This study evaluated the effect of early application of intra-aortic balloon pump (IABP) counterpulsation in patients with ST-segment elevation acute myocardial infarction (STEMI), scheduled for elective percutaneous coronary intervention (PCI). Patients who had experienced STEMI for 12-72 h received (IABP group) or did not receive (control group) IABP counterpulsation for 3-5 days before PCI. One hundred patients were included. Frequencies of infarct-related artery thrombolysis in acute myocardial infarction (TIMI) flow rate classes 0, I and II in the IABP group (11.5, 1.9 and 7.7%, respectively) were significantly lower than in the control group (29.1, 14.6 and 22.9%, respectively) before PCI. After PCI, the frequency of TIMI class III flow rate in the IABP group (96.2%) was significantly higher than that in the control group (81.3%). Four weeks after PCI, the left ventricular ejection fraction (LVEF) was significantly higher, and the incidence of major cardiac events was significantly lower, in the IABP group compared with the control group. Early use of IABP counterpulsation in STEMI patients scheduled for PCI was effective, with a favourable safety profile. IABP counterpulsation reduced the incidence of major adverse cardiac events and improved LVEF. However, IABP devices must be used at an early stage, to obtain optimal results.

Vascular Complications of the Intra-aortic Balloon Pump in Patients Undergoing Open Heart Surgery: 10 Years' Experience

The most encountered complications with intra-aortic balloon pump (IABP) use are seen within the vascular system. The purpose of our study is to evaluate vascular complications of the sheathless IABP in patients undergoing open heart surgery. Between January 2002 and December 2011, a total of 148 patients undergoing open heart surgery and needed IABP support were included in the study. All vascular complications related with IABP were recorded. Mean age of the patients was 64.4 ± 9.4 years. Total 104 (70.2%) were male and 44 (29.8%) were female. Total number of patients who had ischemic complications of the extremity was 13 (8.7%). The most used surgical treatment was embolectomy in five patients. Only one patient required an iliofemoral bypass. Above the knee amputation was performed in one patient. No balloon-related mortality occurred. Incidence of vascular complications in IABP counterpulsation is still a problem despite improvements in catheter design and techniques. The presence of peripheral arterial disease and diabetes mellitus is important risk factors for ischemic complications.

Intra-aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: results of the ALKK-PCI registry

The recommendation for the use of the intra-aortic balloon pump (IABP) as adjunct in patients with cardiogenic shock undergoing primary PCI in current guidelines is controversial. We sought to investigate the use and impact of the outcome of IABP in current practice of percutaneous coronary interventions in Germany. Between January 2006 and December 2011, a total of 55,008 consecutive patients with acute coronary syndromes undergoing PCI in 41 hospitals were enrolled into the prospective Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte registry. Of these, 22,039 had STEMI and 32,969 had NSTEMI, and cardiogenic shock was observed in 1,435 (6.5%) and 478 (1.4%), respectively. Of the total of 1,913 patients with shock, 487 (25.5%) were treated with IABP. In-hospital mortality with and without IABP was 43.5 and 37.4%. In the multivariate analysis, the use of IABP was associated with a strong trend for an increased mortality (odds ratio 1.45, 95% CI 1.15-1.84). In the current clinical practice in Germany, IABP is used only in one quarter of patients with cardiogenic shock treated with primary PCI. We observed no benefit of IABP on outcome, which supports the findings of the randomized IABP-Shock II trial.

Circulation: Clinical Summaries

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A Prospective, Randomized Clinical Trial of Hemodynamic Support With Impella 2.5 Versus Intra-Aortic Balloon Pump in Patients Undergoing High-Risk Percutaneous Coronary Intervention

Although coronary artery bypass grafting is generally preferred in symptomatic patients with severe, complex multivessel, or left main disease, some patients present with clinical features that make coronary artery bypass grafting clinically unattractive. Percutaneous coronary intervention with hemodynamic support may be feasible for these patients. Currently, there is no systematic comparative evaluation of hemodynamic support devices for this indication. We randomly assigned 452 symptomatic patients with complex 3-vessel disease or unprotected left main coronary artery disease and severely depressed left ventricular function to intra-aortic balloon pump (IABP) (n=226) or Impella 2.5 (n=226) support during nonemergent high-risk percutaneous coronary intervention. The primary end point was the 30-day incidence of major adverse events. A 90-day follow-up was required, as well, by protocol. Impella 2.5 provided superior hemodynamic support in comparison with IABP, with maximal decrease in cardiac power output from baseline of -0.04±0.24 W in comparison with -0.14±0.27 W for IABP (P=0.001). The primary end point (30-day major adverse events) was not statistically different between groups: 35.1% for Impella 2.5 versus 40.1% for IABP, P=0.227 in the intent-to-treat population and 34.3% versus 42.2%, P=0.092 in the per protocol population. At 90 days, a strong trend toward decreased major adverse events was observed in Impella 2.5-supported patients in comparison with IABP: 40.6% versus 49.3%, P=0.066 in the intent-to-treat population and 40.0% versus 51.0%, P=0.023 in the per protocol population, respectively. The 30-day incidence of major adverse events was not different for patients with IABP or Impella 2.5 hemodynamic support. However, trends for improved outcomes were observed for Impella 2.5-supported patients at 90 days. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00562016.

Clinical application of intra-aortic balloon pump in patients with serious cardiovascular diseases

To estimate the therapeutic effect and safety of intra-aortic balloon pumps (IABP) in patients with serious cardiovascular diseases. We retrospectively analyzed the clinical data of 68 patients with serious cardiovascular diseases, who were enrolled in Hunan Provincial People's Hospital between 2009 and 2011. All patients received IABP support. The systolic blood pressure, diastolic blood pressure,heart rate, N-terminal precursor of brain natriuretic peptide (NT-proBNP), and renal function of all patients were determined before and after the IABP. Cardiac events and mortality were observed after IABP support. The disease in 51 patients improved after IABP support. The systolic blood pressure, diastolic blood pressure,heart rate, and NT-proBNP were significantly lower than those before the IABP. Thirty-seven patients with acute myocardial infarction successfully completed percutaneous coronary intervention surgery after the IABP support. Five patients had IABP-related complications, but no serious complication occurred. IABP is an effective and safe procedure for critical cardiovascular patients. IABP should be applied early for the patients with appropriate indications.

Use of the Impella 2.5 system alone, after and in combination with an intra-aortic balloon pump in patients with cardiogenic shock: case description and review of the literature

Cardiogenic shock remains a serious complication of acute myocardial infarction as it is associated with very poor prognosis. Despite the historical clinical benefits of the intra-aortic balloon pump (IABP), in some patients additional mechanical cardiac support is necessary. The recent introduction of the percutaneous Impella® 2.5 mechanical circulatory support system (Abiomed Inc., Danvers, MA, USA) represents a major advancement and has been used in these circumstances. Nevertheless, the data supporting the use of this technology alone, after, or in combination with the IABP in patients with cardiogenic shock is limited and the clinical benefits remain unproven. We herein provide an updated comprehensive overview of the literature supporting the use of the Impella 2.5 system compared to the use of IABP in patients with cardiogenic shock. We also discuss the potential role for combination therapy for a patient with refractory shock. We describe a case in which an IABP was used as a bail-out strategy to provide additional haemodynamic support in a patient with refractory cardiogenic shock after the Impella 2.5 system was in place. In selected cases of refractory cardiogenic shock, the use of combined therapy with both the the Impella 2.5 and IABP can provide enhanced circulatory support and could be considered an option to maintain haemodynamic support in these patients.

Beneficial effect of preoperative intra-aortic balloon pumping in patients with low-ejection fraction undergoing coronary artery bypasses grafting

Objective: We evaluated the association between the preoperative use of intraaortic balloon pumping in patients with severely impaired left ventricular function (<30%) undergoing coronary artery bypass grafting.

Cardiogenic shock in ACS. Part 2: role of mechanical circulatory support

This Review explores contemporary circulatory support in profound postinfarction cardiogenic shock. Frequently, death is the only alternative to implantation of a blood pump, so prospective randomized trials of device versus medical treatment are unacceptable and evidence is derived from clinical experience. Irrespective of ACC/AHA and European guidelines, no study has shown survival benefit for the intra-aortic balloon pump in patients with established shock. In the past 10 years, the safety and durability of mechanical blood pumps has improved considerably. New temporary and long-term rotary pumps have transformed outcomes for patients with acute heart failure. For urgent resuscitation, outreach salvage, and transportation extracorporeal membrane oxygenation (ECMO) is a reliable, but time limited, first step. ECMO decompresses the venous system, provides flow, and ensures oxygenation, but does not unload the failing left ventricle. Myocardial stunning takes days, and sometimes weeks, to recover. Effective ventricular unloading is best achieved by surgical implantation of a temporary rotary or volume-displacement pump. After cardiopulmonary resuscitation, hemodynamic stabilization allows assessment of cerebral injury and prognosis. Published series demonstrate that 50-75% of patients with profound shock can be salvaged either through native heart recovery, urgent transplantation, or switch to a long-term pump.

A Clinical Score to Predict the Need for Intraaortic Balloon Pump in Patients Undergoing Coronary Artery Bypass Grafting

A Clinical Score to Predict the Need for Intraaortic Balloon Pump in Patients Undergoing Coronary Artery Bypass Grafting