Benefit Of Intra-aortic Balloon Pump Research Articles

URGENT INTRA-AORTIC BALLOON PUMP DOES NOT REDUCE MORTALITY IN POST CARDIAC ARREST PATIENTS WITH ACUTE CORONARY SYNDROME

Cardiac arrest is the most devastating shock conditions complicating acute coronary syndrome (ACS). Previous observational study showed no benefit of Intra-Aortic Balloon Pump (IABP) use to reduce mortality in cardiogenic shock ACS patients. This study aimed to describe whether urgent insertion of

Factors Associated with Success of Axillary Intra-aortic Balloon Pump as a Bridge to Transplant Strategy

Introduction Several studies have shown lack of benefit of intra-aortic balloon pump (IABP) in the setting of ST-elevation myocardial infarction and cardiogenic shock. However, IABP continues to be used as mechanical circulatory support for bridge to cardiac transplant in patients with acute-on-chronic heart failure. We conducted this study to analyze characteristics that predict successful bridge to transplant with IABP. Methods We did a single-center retrospective analysis of all patients that received percutaneously inserted axillary IABP as BTT from November 2007 to February 2018. Baseline hemodynamic parameters were assessed by right heart catheterization reports and echocardiograms prior to the implantation of IABP. We calculated left ventricular cardiac power output (W) as mean arterial pressure x cardiac output/451. Death on IABP support was defined as any death occurring while on the waitlist for cardiac transplant and on IABP support. We compared the survivors versus non-survivors using Chi-square test for categorical variables and Student's T-test for continuous variables. We did logistic regression analysis on those variables with statistically significant difference (p-value less than 0.05), followed by multivariable analysis. Results Out of 156 patients that had axillary IABP as BTT- 6 patients (3.8%) died while on IABP support whereas 136 (86.5%) patients were successfully bridged to transplant. The remaining 15 patients required escalation of therapy in the form of Impella (5 patients), left ventricular assist device (7 patients) and total artificial heart (3 patients). Patients that died on IABP support had higher right atrial pressure (RAP) and lower left ventricular end diastolic internal diameter (LViDd) compared to patients that survived. The results are shown in Table 1 and Table 2 . Conclusion Our study shows that patients that survived on axillary IABP support had significantly different RAP and LViDd compared to the patients that died. Interestingly, we also found that cardiac power was not predictive of clinical success in these patients.

Contemporary applications of intra-aortic balloon counterpulsation for cardiogenic shock: a "real world" experience.

Intra-aortic balloon pump (IABP) had a pivotal role in the therapy of cardiogenic shock (CS), but recent studies have questioned its effects on patients' outcome. Aim of this study is the description of a "real world" series of patients in which IABP was used as a primary mechanical circulatory support (MCS). All patients who received IABP in our institution during 1 year were prospectively enrolled in our study. The outcomes were: ICU mortality, length of ICU stay, factors associated with mortality and complications of IABP. A logistic regression model was developed to estimate the effect of several risk factors on mortality. A total of 119 patients were enrolled, 54 patients underwent IABP placement for CS unrelated to cardiac surgery (medical CS) and 65 after open-heart surgery. There was no significant difference for mortality between medical CS [12/54 (22.2%)] and cardiac surgery [7/65 (10.8%)] (P=0.09). The morbidity rate related to IABP was 11.3%. Multivariable analysis identified AKI (OR =9.3; 95% CI, 2.0-40.0; P=0.004), inotropic score at the time of IABP implantation (OR =1.06; 95% CI, 1.01-1.11; P=0.009) and history of myocardial revascularization (OR =4.7; 95% CI, 1.1-20.2; P=0.036) as independent predictors for early death (P<0.05). A ROC curve analysis for inotropic score at time of implantation and mortality was performed in the overall population [AUC=0.78 (95% CI, 0.66-0.90)]. A cutoff of 20 has a specificity =72% and sensitivity=74% in this population. Mortality is similar in medical and postcardiotomy CS. The benefits of IABP are limited if the amount of inotropes and the severity of shock are too high.

21 A comparison of coronary haemodynamics in 40cc versus 50cc intra-aortic balloon pumps

IntroductionRandomised trials have questioned the benefit of intra-aortic balloon pump (IABP) counterpulsation in high-risk PCI and shock. A larger capacity balloon has been introduced into routine clinical practice that has...

Newly Shaped Intra-Aortic Balloons Improve the Performance of Counterpulsation at the Semirecumbent Position: An In Vitro Study.

The major hemodynamic benefits of intra‐aortic balloon pump (IABP) counterpulsation are augmentation in diastolic aortic pressure (P aug) during inflation, and decrease in end‐diastolic aortic pressure (ΔedP) during deflation. When the patient is nursed in the semirecumbent position these benefits are diminished. Attempts to change the shape of the IAB in order to limit or prevent this deterioration have been scarce. The aim of the present study was to investigate the hemodynamic performance of six new IAB shapes, and compare it to that of a traditional cylindrical IAB. A mock circulation system, featuring an artificial left ventricle and an aortic model with 11 branches and physiological resistance and compliance, was used to test one cylindrical and six newly shaped IABs at angles 0, 10, 20, 30, and 40°. Pressure was measured continuously at the aortic root during 1:1 and 1:4 IABP support. Shape 2 was found to consistently achieve, in terms of absolute magnitude, larger ΔedP at angles than the cylindrical IAB. Although ΔedP was gradually diminished with angle, it did so to a lesser degree than the cylindrical IAB; this diminishment was only 53% (with frequency 1:1) and 40% (with frequency 1:4) of that of the cylindrical IAB, when angle increased from 0 to 40°. During inflation Shape 1 displayed a more stable behavior with increasing angle compared to the cylindrical IAB; with an increase in angle from 0 to 40°, diastolic aortic pressure augmentation dropped only by 45% (with frequency 1:1) and by 33% (with frequency 1:4) of the drop reached with the cylindrical IAB. After compensating for differences in nominal IAB volume, Shape 1 generally achieved higher P aug over most angles. Newly shaped IABs could allow for IABP therapy to become more efficient for patients nursed at the semirecumbent position. The findings promote the idea of personalized rather than generalized patient therapy for the achievement of higher IABP therapeutic efficiency, with a choice of IAB shape that prioritizes the recovery of those hemodynamic indices that are more in need of support in the unassisted circulation.

INTRA-AORTIC BALLOON PUMP DOES NOT IMPROVE SURVIVAL IN PATIENTS WITH ST SEGMENT ELEVATION MYOCARDIAL INFARCTION COMPLICATED BY CARDIOGENIC SHOCK: DATA FROM A LARGE SINGLE CENTER REGISTRY

Recent evidence from a randomized clinical trial has re-evaluated the benefit of intra-aortic balloon pump (IABP) in patients with STEMI complicated by cardiogenic shock, leading to a downgrading of the recommendation level in the international guidelines. The aim of our study was to evaluate the

Impact of intra-aortic balloon pump on long-term mortality of unselected patients with ST-segment elevation myocardial infarction complicated by cardiogenic shock.

IntroductionA large, randomised trial (IABP-SHOCK II) confirmed no benefit of intra-aortic balloon pump (IABP) on clinical outcomes of patients with ST-segment elevation myocardial infarction (STEMI) complicated by cardiogenic shock. However, the ‘sickest’ patients are often excluded from randomised clinical trials, so it is difficult to generalise expected outcomes from randomized clinical trials to the real life setting.AimWe sought to evaluate the impact of IABP on 1-year mortality of unselected patients with STEMI presenting in cardiogenic shock.Material and methodsData were gathered for 1,650 consecutive patients with STEMI transferred for primary angioplasty from hospital networks in 7 countries in Europe from November 2005 to January 2007 (the EUROTRANSFER registry population). Of them, 51 patients with cardiogenic shock on admission were identified and stratified based on the use of IABP. Outcome results were adjusted for age and sex, to control possible selection bias.ResultsAt the discretion of the operators, IABP was applied in 30 patients (58.8%, IABP group). The remaining 21 patients were treated without IABP (no-IABP group). The use of IABP was more frequent among males, younger patients, and patients with STEMI of the anterior wall. There was no difference in 30-day mortality in patients with and without IABP (no-IABP vs. IABP: 38.1% vs. 33.3%; adjusted OR 1.79 (95% CI 0.43–7.52); p = 0.43). Similarly, IABP had no impact on 1-year mortality (42.9% vs. 33.3%; adjusted OR 1.27 (95% CI 0.32–5.09); p = 0.74). One-year mortality was comparable among patients who survived hospitalisation (14.3% vs. 13%; p = 0.64).ConclusionsWe observed no benefit of IABP on short – and long-term mortality of unselected patients with STEMI complicated by cardiogenic shock.

Combined benefit of intra-aortic balloon pump and percutaneous bypass

Combined benefit of intra-aortic balloon pump and percutaneous bypass