Intra-aortic Balloon Pump Complications Research Articles

The use of intra-aortic balloon pump in cardiac surgery

Background: Objective of the study was to determine the incidence of use, indications, complications of intra-aortic balloon pump (IABP) and its impact on outcome. Methods: Retrospective study of adult cardiac surgical patients presenting for cardiac surgery at Queen Alia Heart Institute in the period of time between September 2023 and February 2024. Patients’ demographic, clinical, perioperative data were recorded and analysed. Time of initiation of intra-aortic balloon, indications and monitoring for complications were observed by the authors. Patients were divided into two groups according to the use of IABP; the IABP group and the non-IABP group. Both groups were compared regarding outcome. Ethical committee approval obtained. Results: Data from 202 adult cardiac surgeries was analysed. Average age of patients was 57.2 years. Patients were 34 females (16.8%) and 168 males (83.2%). Most surgeries were elective (93.6%), while urgent surgeries comprised 3.5% and emergency surgeries were 3%. Coronary artery bypass grafting (CABG) was the most common procedure (78.2%). The IABP was most commonly used after combined procedures (50%) and to a lesser extent after isolated CABG (15.3%). IABP was inserted least frequently pre-operatively (10.7%), followed by postoperative insertion (35.7%), while intraoperative insertion to aid weaning from CPB was most common (53.6%). Patients from the IABP group were older, had longer CPB time (136.7 minutes) and AXC times (70.5 minutes), they also spent around 2 days more in the ICU and around 4 days more in hospital. Conclusions: IABP was most commonly utilised for combined procedures, after prolonged CPB and aortic cross clamping. The use of IABP was associated with delayed tracheal extubation, longer ICU stay, longer hospitalisation, and higher rates of blood transfusion, higher incidence of re-opening and higher mortality.

Clinical profile and in-hospital outcome of patients supported by intra-aortic balloon pump in the clinical setting of cardiogenic shock

BackgroundDespite controversial evidences, intra-aortic balloon pump (IABP) is still the most widely used temporary mechanical support device in cardiogenic shock (CS), as a bridge to recovery or to more invasive mechanical supports/heart transplantation. MethodsWe analyzed retrospectively data of all patients receiving IABP for CS from 2009 to 2018 in a referral centre for advanced heart failure and heart transplantation; we included CS following acute coronary syndrome (ACS) and other CS etiologies different from ACS. We excluded patients in which IABP was implanted as a support following cardiac surgery, non-cardiac surgery in patients with severe chronic heart failure, or in elective high risk or complicated Cath Lab procedures.We focused on in-hospital outcomes (including death, recovery, heart transplantation, LVAD) and IABP complications. Results403 patients received IABP, 303 (75.2%) following ACS and 100 (24.8%) in non-ACS CS. Non-ACS patients were younger (59 ± 18.3 vs 73.1 ± 12.6 years, p < 0.001), had lower median left ventricular ejection fraction (LVEF) (25% [18–35] vs 38% [25–45], p < 0.001). In patients with non-ACS etiologies IABP was more frequently a bridge to heart transplantation [20% (n = 20) vs 0.3% (n = 1), P < 0.001] or LVAD [4% (n = 4) vs 0.6% (n = 2), P = 0.055], while ACS patients were more frequently discharged without transplantation/LVAD [65.7% (n = 199) vs 33% (n = 33), P < 0.001]. Non-ACS patients showed higher in-hospital mortality [46% (n = 46) vs 33.9% (n = 103), P = 0.042]. Post-transplant/LVAD outcome in non-ACS subgroup was favorable (21 out of 24 patients were discharged). Serious IABP-related adverse events occurred in 21 patients (5.2%). Ischemic/hemorrhagic complications, infections and thrombocytopenia were more frequent with longer IABP stay. ConclusionsDespite therapy including percutaneous circulatory support, mortality in CS is still high. In our experience, in the clinical setting of refractory CS an IABP support represents a relatively safe circulatory support, associated with a low rate of serious complications in complex clinical scenarios.

Intra-aortic balloon pump as a bridge therapy to heart transplant in refractory heart failure

Abstract Background The role of intra-aortic balloon pump (IABP) in advanced heart failure (HF) treatment is still under debate. Some heart transplant (HTx) candidates on the waiting list require mechanical support, and IABP may be the simple and most available device. Purpose Describe the impact of IABP treatment in advanced HF patients who underwent HTx. Methods We retrospectively analysis patients who underwent HTx from a single center intensive care unit (ICU), between 2009 and 2018, to evaluate the use of IABP as bridge therapy. Selection included decompensated chronic HF patients that required intensive care with optimized intravenous drugs before IABP placement. Exclusion criteria were acute myocardial infarction or cardiac surgery 90 days prior to admission, and implant of ventricular assist device before HTx. Results We included 134 HF patients with IABP therapy before HTx. Insertion site was exclusively femoral. Mean time of IABP onset to HTx were 26±21 days, and hospital admission to HTx 65±45 days. The main cardiomyopathy etiology was Chagas Disease (46%) and mean LVEF was 23±6% (TABLE 1). Clinical and laboratory data were compared before and 96 hours after IABP therapy. Mean central venous oxygen saturation (SvO2) increased from 49.7±14.6% to 67.4±11.3% (p&amp;lt;0.001), creatinine decreased from 1.77±0.9 mg/dL to 1.40±0.6 mg/dL (p&amp;lt;0.001), and urine output increased from 1552±886 mL/24h to 2189±1029 mL/24h (p&amp;lt;0.001). These differences were sustained or improved until the day before HTx (FIGURE 1). After 96 hours dobutamine was maintained in 98% of patients, nitroprusside increased from 56% to 67%, milrinone decreased from 26% to 20%, and norepinephrine decreased from 18% to 3%. Significant IABP complications were few (5.2%; n=7: 3 infections, 2 major bleeding, 2 arterial injury). Conclusion In this single center ICU sample, IABP improved hemodynamic status and renal function in refractory HF patients waiting for HTx. IABP can be a reasonable, available and effective bridging therapy. Figure 1 Funding Acknowledgement Type of funding source: None

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.

Vascular complications following intra-aortic balloon pump implantation: an updated review.

Background:The use of the intra-aortic balloon pump (IABP) as a support device remains controversial due to the fact that a number of studies have shown no benefit in end mortality whilst using this device. One of the reasons for this could be the increase in vascular complications when using the pump. Therefore, the aim of the present review was to assess the current literature available with regards to IABP vascular complications during the clinical situation.Methods:A literature search was performed, searching for IABP complications in adult human studies between 1990 and 2016.Results:A total of 20 reports were identified as fitting the criteria of this study. The majority of vascular complications were limb ischemia, bleeding or mesenteric ischemia. The overall incidence of vascular complications ranged from 0.94% to 31.1%. Diabetes, peripheral vascular disease and hypertension, as well as smoking were all identified as risk factors for complications following IABP. Furthermore, studies supported the use of sheathless balloon insertion to reduce the risk of complications.Conclusion:Major vascular complications, including limb and mesenteric ischemia as well as bleeding and hemorrhage, have been associated with IABP. However, the incidence of these complications was generally low. Further studies are still required to truly understand the risk/benefit associated with the use of IABP.

Risk factors of perioperative intra-aortic balloon pump complications in cardiac surgery: a 12-year single-institution analysis

To investigate the incidence and risk factors of the complications in perioperative intra-aortic balloon pump (IABP) supported cardiac surgical patients. The clinical data of adult cardiac surgery patients undergoing IABP in Fuwai Hospital from January 2005 to January 2017 were enrolled. The patients were divided into complications group and no complications group. Demographic characteristics, diagnosis, perioperative clinical parameters, IABP related data, and IABP complications (including ischemia, bleeding, vascular injury and mechanical problems) were collected. The incremental risk factors of complications related IABP were analyzed by logistic regression. During the 12-year period, 522 patients received IABP support, with 388 male and 134 female; the mean age was (61.79±9.35) years; the complications related to IABP occurred in 25 patients, and overall complication rate was 4.79%; 87 IABP patients were dead in-hospital, the overall mortality was 16.67%, no patient died due to complications. The complications rate was higher in the female patients (40.00% vs. 24.95%), and was more in patients with age≥65 years old (80.00% vs. 38.03%), more with higher body mass index [BMI (kg/m2): 25.45±13.71 vs. 22.95±3.45], diabetes mellitus (44.00% vs. 26.76%), combination treatment with extra-corporeal membranous oxygenation (ECMO: 20.00% vs. 5.03%) and prolonged IABP support time (hours: 134.4±90.3 vs. 109.8±89.1, all P < 0.05). There was no significant difference in the incidence of complications among preoperative IABP support, intra-operative IABP support and post-operative IABP support [3.30% (3/91), 5.46% (10/183), 4.84% (12/248), χ 2 = 0.629, P = 0.730]. Bleeding from puncture site occurred in 14 cases (2.68%) without severe bleeding. Limb ischemia occurred in 9 cases (1.72%). One patient (0.19%) was under another surgery because of retroperitoneal hemorrhage caused by vascular injury. One patient (0.19%) was unsuccessful due to a balloon leak. It was shown by logistic regression analysis that presence of age ≥ 65 years [odds ratio (OR) = 2.320, 95% confidence interval (95%CI) = 1.011-1.806, P = 0.047], diabetes mellitus (OR = 2.281, 95%CI = 1.016-5.120, P = 0.026) and combination treatment with ECMO (OR = 4.341, 95%CI = 1.240-15.196, P = 0.040) were found to be the risk factors of complications related to IABP. IABP complication rates are generally low. The frequent complications during IABP support is bleeding from site of catheterization and limb ischemia. When patients were treated with IABP, those with older age, diabetes mellitus and combination with ECMO should be monitored closely in order to reduce complications.

Clinical analysis of perioperative application and complications of Intra-aortic Balloon Pump in cardiac surgery

Objective To assess the perioperative efficacy and complications of intra-aortic balloon pump(IABP) in patients with cardiac operation. Methods A total of 36 cases with IABP patients from January 2011 to September 2016 were studied in Luhe Hospital of Beijing Affiliated to Capital Medical University, inluding 27 patients with coronary atherosclerotic heart disease(CAD), 8 patients with valvular heart diseaseand and 1 patient with left atrial myxoma.The clinical data was collected to analyze IABP efficacy and complications. Results There were 10(27.8%) patients died, the mortality rate of CAD patients was lower than that of non-CAD patients(18.5% vs.55.6%, X2=4.615, P=0.032). The related complications after IABP implantation included: 6(16.7%) cases suffered from thrombocytopenia, 3(8.3%) cases with lower limb ischemia, 2(5.6%) cases with lower extremity arterial thromboembolism, 2(5.6%) cases with femoral artery pseudoaneurysm, 2(5.6%) cases with acute pancreatitis, 1(2.8%) cases with intestinal necrosis by mesenteric ischemia, 2(5.6%) cases with gastrointestinal bleeding, 3(8.3%) cases with hemorrhage in puncture site, 4(11.1%) cases of fever, 1(2.8%) case with pipeline leak, and 1(2.8%) case no pressure lumen data.After treatment with IABP, in 26 cases survival patients, the hemodynamic indexes(mean arterial pressure, heart rate, central venous pressure, urine volume) were significantly improved and the amount of dopamine and epinephrine decreased(t=-22.35, 64.41, 53.31, -23.82, 26.07, 14.15 respectively, P<0.05). Conclusion IABP can significantly improve the perioperative efficacy.The active treatment on complications is important to reduce the death induced by IABP. Key words: Intra-aortic balloon pump; Perioperative period of cardiac operation; Complication

Aortic Dissection Complicating Intraaortic Balloon Pumping: Percutaneous Management of Delayed Spinal Cord Ischemia

Iatrogenic acute type B dissection is a rare complication of intraaortic balloon pumping. Delayed visceral and spinal cord malperfusion can occur for distal progression of the dissection or relative hypotension. Cerebrospinal fluid drainage and percutaneous balloon fenestration provide a safe and effective method for managing ischemic complications.

Acute thoracic aortic thrombosis after intra-aortic balloon pumping

We present two transesophageal echocardiographic images of a patient with acute myocardial infarction, demonstrating a large thrombus attached to the thoracic aortic wall, considered to be a complication of intra-aortic balloon pumping. The patient had received the device because of hemodynamic instability due to an infarct-related ventricular septal defect. Clinical manifestations which led to the diagnosis of thromboembolism were abdominal pain and deterioration of renal function, without signs of limb ischemia.

Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction: The benchmark registry

ObjectivesWe sought to examine contemporary utilization patterns and clinical outcomes in patients with acute myocardial infarction (AMI) requiring intra-aortic balloon pump (IABP) counterpulsation. BackgroundDespite increasing experience with and broadened indications for intra-aortic counterpulsation, the current indications, associated complications, and clinical outcomes of IABP use in AMI are unknown. MethodsBetween June 1996 and August 2001, data were prospectively collected from 22,663 consecutive patients treated with aortic counterpulsation at 250 medical centers worldwide; 5,495 of these patients had AMI. ResultsPlacement of an IABP in AMI patients was most frequently indicated for cardiogenic shock (27.3%), hemodynamic support during catheterization and/or angioplasty (27.2%) or prior to high-risk surgery (11.2%), mechanical complications of AMI (11.7%), and refractory post-myocardial infarction unstable angina (10.0%). Balloon insertions were successful in 97.7% of patients. Diagnostic catheterization was performed in 96% of patients, and 83% underwent coronary revascularization before hospital discharge. The in-hospital mortality rate was 20.0% (38.7% in patients with shock) and varied markedly by indication and use of revascularization procedures. Major IABP complications occurred in only 2.7% of patients, despite median use for three days, and early IABP discontinuation was required in only 2.1% of patients. ConclusionsWith contemporary advances in device technology, insertion technique, and operator experience, IABP counterpulsation may be successfully employed for a wide variety of conditions in the AMI setting, providing significant hemodynamic support with rare major complications in a high-risk patient population.

Air transport of the IABP patient

The intra-aortic balloon pump (IABP) has evolved into an easily transported, computer-driven device for invasively assisting circulation. This article reviews the use of the IABP during interfacility patient transport by air. Air transport of the IABP-dependent patient creates unique clinical, logistical, and technical challenges. We review the function and clinical application of IABP in various air transport conditions. We also identify the complications of intra-aortic balloon pumping, such as hemorrhage, loss of trigger signals, cardiac arrest, and atmospheric pressure changes, and offer solutions. The effective clinical use of IABP in the air transport environment involves more than familiarity with the device and implications for its use; rapid identification of problems and implementation of solutions are required for successful transport and patient outcomes.

Intra-aortic balloon pump complications: A five-year retrospective study of 283 patients

Objective: To determine the type, incidence, and risk factors for complication with the intra-aortic balloon pump. Design: Descriptive, chart review. Setting: Midwestern community teaching hospital. Patients: Two hundred eighty-three patients with 287 intra-aortic balloon pump insertions from January 1, 1990, to December 31, 1994. Outcome Measures: Complications of therapy. Results: Seventeen percent of balloon insertions resulted in minor complications, and 14 patients had major complications. Polychotomous logistic regression was used to determine which study risk factors were predictive of the development of minor or major complications in patients. Patients with longer balloon duration had an increased risk of a major complication; whereas smokers and patients with lower body mass index had an increased probability of the development of a minor complication. (Heart Lung ® 1999;28:195-202)

Gender and other predictors of intraaortic balloon pump complications: prospective study of 1,119 consecutive patients at single high volume, tertiary care center

Gender and other predictors of intraaortic balloon pump complications: prospective study of 1,119 consecutive patients at single high volume, tertiary care center

Gender and Other Predictors of Intraaortic Balloon Pump Complications: Prospective Study of 1,119 Consecutive Patients at Single High Volume, Tertiary Care Center

Gender and Other Predictors of Intraaortic Balloon Pump Complications: Prospective Study of 1,119 Consecutive Patients at Single High Volume, Tertiary Care Center

The Intraaortic Balloon Pump for Postcardiotomy Heart Failure

The intraaortic balloon pump (IABP) is usually the first mechanical device inserted for perioperative heart failure. In the present study we have reviewed our experience with 169 IABP insertions with emphasis on IABP complications, route of insertion, and identification of predictors of mortality. Between January 1, 1984 and March 31, 1993 3,591 adult patients underwent cardiac surgical procedures, 169 of whom (4.7%) had an IABP inserted preoperatively (7 patients, 4.1%), intraoperatively (109 patients, 64.5%), or postoperatively (53 patients, 31.4%). There were 137 men (81.1%) and the mean age was 60.2 +/- 8.8 years (28-78 years). Operations included 149 coronary bypass grafting (CABG) (4.6%, 149/3,209), 6 valve replacements, single or double (2.4%, 6/255), and 14 valves combined with CABG (11.0%, 14/127). The IABP was used more frequently in reoperations (14.8%, 80/542), compared to primary operations (2.9%, 89/3,049), p < 0.001. It was also more frequently used after emergency operations (50.7%, 39/77), than after elective operations (3.7%, 130/3,514), p < 0.001. In 119 patients femoral insertion was performed (13 percutaneously and 106 surgically), while 50 patients had an intraaortic insertion. The mean duration of IABP support was 50 hours (0.5-576 hours). There were 8 (4.7%) complications related to the balloon pump, all after femoral insertion (3 after transcutaneous and 5 after surgical insertions). Six of the complications occurred when the IABP was inserted intraoperatively and 2 postoperatively. The complications were 7 cases of leg ischemia (88%) and 1 groin wound infection.(ABSTRACT TRUNCATED AT 250 WORDS)

Complication of intra-aortic balloon pumping in a pediatric patient

A serious complication was seen following insertion of an intra-aortic balloon pump in the ascending aorta in a pediatric patient. The catheter initially coursed to the left subclavian artery from which it folded upon before finding its way in the descending aorta. We recommend that a suitably curved J-tip guidewire be used to guide the IABP balloons distal to the aortic arch into the descending aorta, so as to avoid potentially fatal complications.

Intraaortic balloon entrapment

A review of intraaortic balloon pump use at the University of Miami/Jackson Memorial Medical Center over the past 21 years identified 2 cases where a balloon was found to be entrapped. The balloon catheters had been in place for approximately 10 days when this complication occurred. The retained balloons were torn, filled with clotted blood, and impacted in the vasculature. In our first case, forceful removal of the intraaortic balloon was complicated by unintentional extraction of the external iliac and common femoral arteries. In the second case, clot within the balloon was dissolved with tissue plasminogen activator injected into the drive lumen of the catheter before removal. The prevention and management of this rare but serious complication of intraaortic balloon pumping is reviewed.

Entrapping of the clotted intra-aortic ballon in the descending aorta

Percutaneous insertion of a catheter for intra-aortic balloon pumping (IABP) was introduced in 1979 by Bregman and Casarella and has become a popular technique. Rupture of the balloon, allowing clot to form inside it, is rare. When the clot is large, it may cause entrapping of the balloon. This is a potentially dangerous complication of IABP. We are aware of only one case report of this complication, by Aru and co-workers. The entrapping of the balloon in their report occurred at the site of insertion in the femoral artery. We report here a case in which the entrapping occurred in the descending aorta, and its removal required extensive exposure of the aortic bifurcation.

Compartment syndrome as a complication of intra-aortic balloon pumping

Intra-aortic balloon pumping (IABP) is a well accepted therapy in low cardiac output states. The complications reported with the use of IABP are varied. Development of a swollen, tender calf and loss of sensation and/or function, yet retaining a warm limb with the palpable peripheral pulses during or immediately after IABP is one such complication. We believe that this represents compartment syndrome following temporary or partial ischaemia. We set out to measure the compartment pressure in 13 patients in whom IABP was used following coronary artery bypass graft surgery. Our results show that the slit catheter method used in this study to measure compartment pressures gave reliable results, was easy to set up and use and provided early warning of compartment syndrome, thus facilitating early treatment and viability of all limbs affected.

Intraaortic balloon pumping 1967 through 1982: Analysis of complications in 733 patients

Between June 1967 and December 1982, 872 attempts at intraaortic balloon pumping (IABP) were made in 733 patients. Nearly 75% of the patients were men; the proportion of women has increased in recent years. The principal indication for IABP support initially was cardiogenic shock, but over the years, preoperative support, weaning from cardiopulmonary bypass and unstable angina have become the primary indications. Complications of IABP were classified and distributed by severity (minor: I [15%] and II [26%]; major: III [3%] and IV [1%]) and type ([vascular [22%], infectious [22%], and bleeding [7%]). Vascular complication rates were higher in women (32 vs 18%, p = 0.0001), in diabetic patients (32 vs 20%, p = 0.003), and in hypertensive patients (27 vs 20%, p = 0.02). These did not vary with the duration of IABP support (range of duration 0 to 76 days). The rate of infectious complications was related to location where IABP was performed (coronary care unit 26%, operating room 12%). The rate of fever and bacteremia increased significantly with duration of IABP support, but the rate of local wound infection did not. In conclusion, most IABP complications are minor, resolve after balloon removal, are related to vascular status of the patient and, with the exception of bacteremia, are independent of IABP duration.