Effects Of Intra-aortic Balloon Pump Research Articles

Left ventricular decompression on Veno-arterial extracorporeal membrane oxygenation with intra-aortic balloon Counterpulsation

BackgroundVeno-arterial extracorporeal membrane oxygenation (VA-ECMO) has been used increasingly to support patients with cardiogenic shock (CS). There has been growing recognition of the favorable and unfavorable hemodynamic effects of this therapy and recent interest in the use of other percutaneous circulatory support devices to offset some of the potentially harmful hemodynamic effects. Herein, we provide visual evidence of the effects of intra-aortic balloon pump (IABP) counterpulsation for a patient with peripheral VA-ECMO cannulation.Case presentationA 68 year old man who had undergone orthotopic heart transplantation presented with 2 days of fatigue, orthopnea, and paroxysmal nocturnal dyspnea. On examination, he was tachycardic, hypotensive and hypoxic with cool extremities, consistent with CS. Transthoracic echocardiogram (TTE) showed new severe biventricular dysfunction with a left ventricular ejection fraction of 15%, right heart catheterization demonstrated elevated filling pressures and low output. An IABP was inserted via the left femoral artery with minimal improvement in hemodynamics. He was escalated to VA-ECMO. Repeat TTE demonstrated aortic valve (AV) opening with each cardiac cycle and mild MR. With placement of the IABP on standby Additional file 1: Video 1 (video 0:03), the AV no longer opened. Re-initiation of balloon counterpulsation resulted in resumed AV opening with each beat Additional file 1: Video 1 (video 0:17). He was treated for presumed acute allograft rejection with methylprednisolone, thymoglobulin, intravenous immunoglobulin and plasmapheresis with improvement in allograft function. However, he developed an Enterobacter aerogenes pneumonia and rapidly fatal septic shock.ConclusionsThis case visually demonstrates effective LV decompression by IABP counterpulsation in VA-ECMO support. While the overall effects of LV decompression in patients on VA-ECMO with IABP are still unclear, this report demonstrates one potential mechanism of benefit in the prevention of stagnation of blood flow that may lead to intra-cardiac or aortic root thrombus formation.

Numerical analysis of aortic hemodynamics under the support of venoarterial extracorporeal membrane oxygenation and intra-aortic balloon pump

Background and objectiveA gap still exists in the hemodynamic effect of intra-aortic balloon pump (IABP), venoarterial extracorporeal membrane oxygenation (VA-ECMO), and VA-ECMO plus IABP on the blood perfusion of the coronary artery, brain, and lower limb; the relation between heart flow and ECMO flow; and the wall stress of vessels. MethodsA finite-element model of the aorta, ECMO, and IABP was proposed to calculate the mechanical response via fluid–structure interaction. Heart failure (HF), IABP, ECMO, and ECMO plus IABP were utilized to study the effect of support models. ResultsFor the pressure curve, VA-ECMO weakened the dicrotic notch of pressure compared with HF and the pulsatile index (0.494 vs. 0.706 vs. 0.471 vs. 0.613). IABP, ECMO, and ECMO plus IABP increased the perfusion of the coronary, brain, and renal artery compared with HF. However, ECMO and ECMO plus IABP clearly reduced the blood flow of the left arteria femoralis compared to that of the right arteria femoralis (ECMO: 194.04 vs. 730.80 mL/min; ECMO plus IABP: 342.15 vs. 947.22 mL/min). In addition, the flow of ECMO accessed the renal artery more than the left ventricular flow. Greater ventricular flow perfused to the renal artery at a diastolic period for ECMO plus IABP, especially at the time points of 2.192 s and 2.304 s. Compared to the velocity distribution with ECMO, the flow of the right arteria femoralis was increased in the process of IABP-on. According to these four cases, the stress of the vascular wall was increased for ECMO support at the systolic period. The peak wall stress of ECMO is increased by 20% at 1.68 s. ConclusionsECMO plus IABP is more conducive to the blood supply than other cases from the result of numerical simulation. The location of blood intersection was generated in the region of the renal artery, which is estimated carefully.

Outcomes with intra-aortic balloon pump in high risk cardiac surgery patients

ABSTRACT Introduction: In high-risk cardiac surgical patients the intra-aortic balloon pump (IABP) is the most frequent used tool for temporary mechanical circulatory support during the perioperative phase. The effects of IABP are an increase in diastolic blood pressure, an improvement in coronary perfusion and a reduction of ventricular afterload, so it increases the stroke volume and cardiac output. Objective: To study the effect of preoperative use of intra-aortic balloon pump (IABP) on the outcome of high-risk patients that were subjected to coronary artery bypass graft (CABG) surgery. Methods: From June 2009 to June 2011. Group of 100 patients considered as high-risk patients were subjected to elective bypass cardiac surgery at our center. Forty patients subjected to preoperative IABP as a prophylactic measure and 60 patients were not subjected to IABP. This is retrospective study of prospectively collected data .The definition of High risk was the presence of two or more known risk factors. The patient’s outcome is compared regarding the predicted mortality of the Euro SCORE. The preoperative effect of IABP on the outcome, mortality and 30 days follow-up was statistically analyzed. Results: Forty patients subjected to preoperative IABP as prophylactic measure due to higher Euro SCORE-predicted mortality than other 60 patients did not subject to IABP(60% vs 40 %, P = ˂0.05). Seventy patients (70%) were male while (30%) were female with a mean age of 58.62 ± 9.65 years. Patients subjected to preoperative IABP had increased a percentage of hospital mortality (P = ˂0.05) but this percentage is relatively lower than predicted by Euro SCORE. Patients subjected to preoperative IABP had lower rate of postoperative complication (acute kidney insult (P = 0.045), cardiac surgical intensive care unit (CSICU) stay (P = 0.032) and decrease the need for postoperative inotrope (P = 0.046)) compared to patients without preoperative IABP use. Other complications postoperative were low and similar in both groups. Conclusions: We conclude that patients have high-risk CABG, the preoperative IABP in this group with higher predicted mortality was associated with a relative reduction than predicted by Euro score. The preoperative IABP in this group has a reliable and acceptable outcome on postoperative complications. Keywords: intra-aortic balloon pump, High Risk, Cardiac Surgery

Short-term outcomes of intra-aortic balloon pump combined with venoarterial extracorporeal membrane oxygenation: A systematic review and meta-analysis.

The effectiveness of intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock or cardiac arrest remains controversial. The aim of this systematic review and meta-analysis was to investigate the short-term clinical outcomes of IABP combined with VA-ECMO versus VA-ECMO alone. We searched PubMed, Embase, and the Cochrane Library for English language articles published from inception to August 18, 2018. Observational studies comparing IABP combined with VA-ECMO with VA-ECMO were considered eligible for the current study. Twelve observational studies with 3704 patients were included. In the IABP combined with VA-ECMO group mortality was 59.7%, compared with 65.8% in the VA-ECMO alone group. The risk ratio (RR) for this comparison was 0.90 (95% confidence interval [CI], 0.80-1.02; P=0.107; 59.7% vs. 65.8%). In the one-way sensitivity analysis for estimating the effect of each study on mortality, omission of each study did not make a significant difference. Furthermore, the proportion of patients weaned from VA-ECMO was significantly higher in IABP combined VA-ECMO group than in the VA-ECMO alone group (RR, 1.28; 95% CI, 1.21-1.35; P<0.001; 77.9% vs. 61.2%). IABP combined with VA-ECMO could improve success rate of weaning from VA-ECMO, but did not reduce in-hospital mortality in patients with cardiogenic shock or cardiac arrest.

Оценка эффективности внутриаортальных баллонов с волоконно-оптическим датчиком

&lt;p&gt;&lt;b&gt;Цель исследования&lt;/b&gt; – оценка эффективности волоконно-оптической системы для внутриаортальной баллонной контрпульсации (ВАБК) у пациентов, перенесших кардиохирургическое вмешательство. &lt;p&gt;&lt;b&gt;Материал и методы.&lt;/b&gt; В исследование включены 39 больных (25 мужчин и 14 женщин) с острой левожелудочковой недостаточностью, возникшей в интра- или раннем послеоперационном периоде. Возраст больных колебался от 43 до 77 лет и в среднем составил 63,51±7,27 года. Пациенты были разделены на две группы: 1-я группа (n=20) – пациенты, у которых устанавливали внутриаортальный баллон для контрпульсации с волоконно-оптическим датчиком, 2-я группа (n=19) – пациенты, которым устанавливали ВАБК с Fluied-Field технологией. Всем больным была выполнена операция реваскуляризации миокарда. У 2 (5,1%) пациентов проведена эндартерэктомия из коронарных артерий, у 26 (66,7%) – операция геометрической реконструкции ЛЖ по V.M. Dor. Для измерения показателей центральной гемодинамики всем пациентам перед операцией был установлен катетер Swan–Ganz. &lt;p&gt;&lt;b&gt;Результаты.&lt;/b&gt; Общая летальность составила 30,76% (n=12), летальность в группе с обычными баллонами (2-я) – 36,84% (n=7), в группе с волоконно-оптической системой (1-я) – 25% (n=5) (p=0,4). После операции в 1-й группе диастолическое АД выросло на 20%, среднее АД – на 11%, сердечный индекс (СИ) увеличился на 10%, индекс ударной работы левого желудочка (ИУРЛЖ) – на 11%, давление заклинивания легочных капилляров (ДЗЛК) снизилось на 12%. Также отмечалось уменьшение ко- нечного диастолического давления в аорте на 6%. Во 2-й группе наблюдалось улучшение гемодина- мических параметров: диастолическое АД увеличилось на 14%, среднее АД – на 9%, СИ вырос на 7%, ИУРЛЖ – на 8%, достоверного снижения ДЗЛК выявлено не было (p=0,69). При сравнении параметров ЭхоКГ до и после операции статистически значимых различий не выявлено, кроме показателя фракции выброса, который составил 37,45±10,14% (p=0,04) в 1-й группе и 34,68±8,09% (p=0,02) – во 2-й, при сравнимой кардиотонической поддержке адреналином (0,08±0,02 мкг/кг/мин) и добутамином (10±2 мкг/кг/мин). &lt;p&gt;&lt;b&gt;Заключение.&lt;/b&gt; Внутриаортальная баллонная контрпульсация с волоконно-оптическим датчиком как метод вспомогательного кровообращения, способствующий снижению постнагрузки и путем увеличения коронарного кровотока позволяющий сбалансировать соотношение доставки и потребности миокарда в кислороде, является эффективным и наименее инвазивным методом в арсенале систем вспомогательного кровообращения, достоверно улучшающим показатели центральной гемодинамики. HTML

A Point of Controversy in Therapy for Patients with Acute Coronary Syndromes: The Effectiveness of Intra-aortic Balloon Pump (IABP) for Acute Myocardial Infarction in Patients with Cardiogenic Shock

A Point of Controversy in Therapy for Patients with Acute Coronary Syndromes: The Effectiveness of Intra-aortic Balloon Pump (IABP) for Acute Myocardial Infarction in Patients with Cardiogenic Shock

Assessment of Intra-Aortic Counterpulsation in an Animal Model of Heart Failure and Myocardial Ischemia.

The effectiveness of intra-aortic balloon pumping (IABP) is currently evaluated using indirect indexes. The diastolic pressure augmentation is quantified using the subendocardial viability ratio (SEVR) and the DABAC/SABAC index (areas beneath the aortic pressure-time signals during the diastolic and systolic periods, respectively). The SEVR requires invasive recordings of left ventricular pressure; the DABAC/SABAC index may represent an alternative, since it only requires an aortic pressure signal. Nonetheless, it has never been used in an animal model of counterpulsated heart failure and ischemia-reperfusion episode. The aims of this work were: (i) to develop an animal model of heart failure, with a myocardial ischemia-reperfusion episode, treated with IABP during the reperfusion period; (ii) to evaluate the effects of the IABP using the SEVR and DABAC/SABAC indices; and (iii) to assess the relationship between both ratios. Cardiovascular parameters were obtained in anesthetized sheep, in which induced heart failure and ischemia-reperfusion episodes were monitored with and without IABP 1:2. Systolic and diastolic blood pressure signals were assessed in the aorta and in the left ventricle. Values of cardiac output and left ventricular wall thickness signals were obtained. Induction of ischemia and heart failure determined decreases in SEVR and DABAC/SABAC indices with respect to their basal stage (0.807±0.118 vs. 0.601±0.107, P<0.05 and 1.062±0.136 vs. 0.902±0.161, P<0.05, respectively). Counterpulsated animals whose myocardial reperfusion was accompanied by heart failure showed a significant improvement of wall thickening fraction along time (R2 =0.7627, P<0.001). During counterpulsated heart failure accompanied by myocardial reperfusion, the SEVR was positively correlated with DABAC/SABAC index.

OUTCOMES WITH INTRA-AORTIC BALLOON PUMP IN HIGH RISK CARDIAC SURGERY PATIENTS

ABSTRACT Introduction: In high-risk cardiac surgical patients the intra-aortic balloon pump (IABP) is the most frequent used tool for temporary mechanical circulatory support during the perioperative phase. The effects of IABP are an increase in diastolic blood pressure, an improvement in coronary perfusion and a reduction of ventricular afterload, so it increases the stroke volume and cardiac output. Objective: To study the effect of preoperative use of intra-aortic balloon pump (IABP) on the outcome of high-risk patients that were subjected to coronary artery bypass graft (CABG) surgery. Methods: From June 2009 to June 2011. Group of 100 patients considered as high-risk patients were subjected to elective bypass cardiac surgery at our center. Forty patients subjected to preoperative IABP as a prophylactic measure and 60 patients were not subjected to IABP. This is retrospective study of prospectively collected data .The definition of High risk was the presence of two or more known risk factors. The patient’s outcome is compared regarding the predicted mortality of the Euro SCORE. The preoperative effect of IABP on the outcome, mortality and 30 days follow-up was statistically analyzed. Results: Forty patients subjected to preoperative IABP as prophylactic measure due to higher Euro SCORE-predicted mortality than other 60 patients did not subject to IABP(60% vs 40 %, P = ˂0.05). Seventy patients (70%) were male while (30%) were female with a mean age of 58.62 ± 9.65 years. Patients subjected to preoperative IABP had increased a percentage of hospital mortality (P = ˂0.05) but this percentage is relatively lower than predicted by Euro SCORE. Patients subjected to preoperative IABP had lower rate of postoperative complication (acute kidney insult (P = 0.045), cardiac surgical intensive care unit (CSICU) stay (P = 0.032) and decrease the need for postoperative inotrope (P = 0.046)) compared to patients without preoperative IABP use. Other complications postoperative were low and similar in both groups. Conclusions: We conclude that patients have high-risk CABG, the preoperative IABP in this group with higher predicted mortality was associated with a relative reduction than predicted by Euro score. The preoperative IABP in this group has a reliable and acceptable outcome on postoperative complications. Keywords: intra-aortic balloon pump, High Risk, Cardiac Surgery

Insufficient left ventricular unloading after extracorporeal membrane oxygenation : Acase-series observational study.

Extracorporeal membrane oxygenation (ECMO) is amethod widely used to support circulation in patients with fulminant myocarditis (FM). However, acommon complication associated with ECMO is left ventricular (LV) overload. This case series observed the effects of intra-aortic balloon pump (IABP) and beta-blockers for the treatment of LV overload after ECMO. The cases of eightpatients with FM who underwent ECMO from September 2009 to July 2016 were reviewed. Six of the eightpatients survived. After ECMO treatment, insufficient LV unloading occurred in sixpatients. Among these sixpatients, threeexperienced electrical storm but spontaneous circulation returned after interventions with beta-blockers and IABP. The survivors demonstrated full recovery of cardiac function. Beta-blockers may prevent the occurrence of electrical storm, and IABP is feasible for the treatment of LV overload after ECMO application.

Retrospective Analysis of Transcranial Doppler Patterns in Veno-Arterial Extracorporeal Membrane Oxygenation Patients: Feasibility of Cerebral Circulatory Arrest Diagnosis.

Transcranial Doppler (TCD) is able to detect cerebral hemodynamic changes in real-time. Impairment of cerebral blood flow during veno-arterial (VA) extracorporeal membrane oxygenation (ECMO) treatment is referred to in the literature. Several cerebrovascular complications can affect VA ECMO patients, eventually leading to brain death (BD). Transcranial Doppler is a worldwide accepted technique for cerebral circulatory arrest (CCA) diagnosis for BD confirmation, and in Italy, it is mandatory in certain clinical conditions. Nowadays, no data have been published on the use of TCD as a confirmation test in VA ECMO patients evolved to BD. The aim of our study was to investigate the feasibility of TCD in CCA diagnosis during VA ECMO treatment. Thirty-two TCD examinations, performed in 25 patients on VA ECMO, were retrospectively analyzed, and factors that could be responsible for TCD waveforms abnormalities were reviewed. Differences in TCD patterns were detected depending on values of left ventricular ejection fraction and the absence or presence of intraaortic balloon pump (IABP). Four categories of different TCD patterns were then identified. In five BD patients, diagnostic CCA patterns in all cerebral arteries were identified by TCD. Our data suggest that cerebral hemodynamic changes due to both residual cardiac function and the effects of IABP can be detected by TCD in VA ECMO patients. In the case of BD, TCD seems to be a reliable instrumental test for CCA diagnosis in patients on VA ECMO when a pulsatile flow is maintained (native or IABP support).

Computational prediction of the effects of the intra-aortic balloon pump on heart failure with valvular regurgitation using a 3D cardiac electromechanical model

Intra-aortic balloon pump (IABP) is normally contraindicated in significant aortic regurgitation (AR). It causes and aggravates pre-existing AR while performing well in the event of mitral regurgitation (MR). Indirect parameters, such as the mean systolic pressure, product of heart rate and peak systolic pressure, and pressure–volume are used to quantify the effect of IABP on ventricular workload. However, to date, no studies have directly quantified the reduction in workload with IABP. The goal of this study is to examine the effect of IABP therapy on ventricular mechanics under valvular insufficiency by using a computational model of the heart. For this purpose, the 3D electromechanical model of the failing ventricles used in previous studies was coupled with a lumped parameter model of valvular regurgitation and the IABP-treated vascular system. The IABP therapy was disturbed in terms of reducing the myocardial tension generation and contractile ATP consumption by valvular regurgitation, particularly in the AR condition. The IABP worsened the problem of ventricular expansion induced as a result of the regurgitated blood volume during the diastole under the AR condition. The IABP reduced the LV stroke work in the AR, MR, and no regurgitation conditions. Therefore, the IABP helped the ventricle to pump blood and reduced the ventricular workload. In conclusion, the IABP partially performed its role in the MR condition. However, it was disturbed by the AR and worsened the cardiovascular responses that followed the AR. Therefore, this study computationally proved the reason for the clinical contraindication of IABP in AR patients.

The Effect of Intraaortic Balloon Pumping Under Venoarterial Extracorporeal Membrane Oxygenation on Mortality of Cardiogenic Patients: An Analysis Using a Nationwide Inpatient Database.

The role of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation in cardiogenic shock patients remains unknown. This study investigated the effect of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation on reducing mortality of cardiogenic shock patients. Retrospective cohort study. The Japanese Diagnosis Procedure Combination national inpatient database. Cardiogenic shock adult patients receiving peripheral venoarterial extracorporeal membrane oxygenation at admission were identified in the Japanese Diagnosis Procedure Combination database from July 1, 2010, to March 31, 2013. None. The primary outcomes were all-cause 28-day mortality and in-hospital mortality, and the secondary outcome was the proportion of patients weaned from venoarterial extracorporeal membrane oxygenation, using propensity score matching. Eligible patients (n = 1,650) were divided into the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group (n = 604) and the venoarterial extracorporeal membrane oxygenation-alone group (n = 1,064). Propensity score matching created matched cohort of 533 pairs. In the propensity score-matched analysis, all-cause 28-day mortality and in-hospital mortality were significantly lower in the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group than the venoarterial extracorporeal membrane oxygenation-alone group (48.4% vs 58.2%; p = 0.001 and 55.9% vs 64.5%; p = 0.004, respectively). In Cox regression, there was a significant difference in survival between the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group and the venoarterial extracorporeal membrane oxygenation-alone group (hazard ratio, 0.74; 95% CI, 0.63-0.86; p < 0.001). The proportion of patients weaned from venoarterial extracorporeal membrane oxygenation was significantly higher in the intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation group than in the venoarterial extracorporeal membrane oxygenation-alone group (82.6% vs 73.4%; p < 0.001). In a national inpatient database, intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation was associated with improved mortality and successful weaning from venoarterial extracorporeal membrane oxygenation. Randomized controlled studies are required to confirm the mortality-reducing effect of intraaortic balloon pumping combined with venoarterial extracorporeal membrane oxygenation.

The response of the microcirculation to mechanical support of the heart in critical illness.

Critical illness associated with cardiac pump failure results in reduced tissue perfusion in all organs and occurs in various conditions such as sepsis, cardiogenic shock, and heart failure. Mechanical circulatory support (MCS) devices can be used to maintain organ perfusion in patients with cardiogenic shock and decompensated chronic heart failure. However, correction of global hemodynamic parameters by MCS does not always cause a parallel improvement in microcirculatory perfusion and oxygenation of the organ systems, a condition referred to as a loss of hemodynamic coherence between macro- and microcirculation (MC). In this paper, we review the literature describing hemodynamic coherence or loss occurring during MCS of the heart. By using Embase, Medline Cochrane, Web of Science, and Google Scholar, we analyzed the literature on the response of MC and macrocirculation to MCS of the heart in critical illness. The characteristics of patients, MCS devices, and micro- and macrocirculatory parameters were very heterogenic. Short-term MCS studies (78%) described the effects of intra-aortic balloon pumps (IABPs) on the MC and macrocirculation. Improvement in MC, observed by handheld microscopy (orthogonal polarization spectral (OPS), sidestream dark-field (SDF), and Cytocam IDF imaging) in line with restored macrocirculation was found in 44% and 40% of the studies of short- and long-term MCS, respectively. In only 6 of 14 studies, hemodynamic coherence was described. It is concluded that more studies using direct visualization of the MC in short- and long-term MCS by handheld microscopy are needed, preferably randomized controlled studies, to identify the presence and clinical significance of hemodynamic coherence. It is anticipated that these further studies can enable to better identify patients who will benefit from treatment by mechanical heart support to ensure adequate organ perfusion.

GW27-e0365 A Meta-analysis of the efficacy and safety of adjunctive intra-aortic balloon pump in patients with acute myocardial infarction

There is widespread controversy regarding the effectiveness of intra-aortic balloon pump (IABP) in acute myocardial infarction (AMI); moreover, little is known about the long term mortality. Here to evaluate the efficacy and safety for IABP in AMI patients by conducting a meta-analysis of randomized

Editor's Choice- Impact of immediate multivessel percutaneous coronary intervention versus culprit lesion intervention on 1-year outcome in patients with acute myocardial infarction complicated by cardiogenic shock: Results of the randomised IABP-SHOCK II trial.

Current guidelines recommend immediate multivessel percutaneous coronary intervention (PCI) in patients with cardiogenic shock, despite the lack of randomised trials. We sought to investigate the use and impact on outcome of multivessel PCI in comparison to culprit lesion only PCI in a retrospective analysis in patients with cardiogenic shock complicating acute myocardial infarction. In the randomised IABP-SHOCK II trial, investigating the effect of intra-aortic balloon pump on outcome, 451 (75%) of the total of 600 patients had multivessel coronary artery disease and underwent PCI. Immediate multivessel PCI was performed in 167 (37%) patients. TIMI 3 patency after PCI in all treated vessels was observed in 83.2% versus 79.0% of patients after multivessel versus culprit lesion PCI, respectively. The 30-day (44.9% vs. 42.3%) and 12-month (54.8% vs. 52.7%) mortality rates did not significantly differ between the two groups. In the multivariate analysis multivessel PCI was not associated with an improved mortality after 12 months (odds ratio 0.92, 95% confidence intervals 0.69-1.21). In this retrospective analysis of the largest randomised study in cardiogenic shock immediate multivessel PCI was used in approximately one third of patients with cardiogenic shock. There was no benefit with immediate multivessel PCI in comparison to culprit lesion only PCI. Therefore a randomised trial is needed to determine the definitive role of multivessel PCI in cardiogenic shock. ClinicalTrials.gov , NCT00491036.

Benefits of Intraaortic Balloon Support for Myocardial Infarction Patients in Severe Cardiogenic Shock Undergoing Coronary Revascularization.

BackgroundPrior studies have suggested intraaortic balloon pump (IABP) have a neutral effect on acute myocardial infarction (AMI) patients with cardiogenic shock (CS). However, the effects of IABP on patients with severe CS remain unclear. We therefore investigated the benefits of IABP in AMI patients with severe CS undergoing coronary revascularization.Methods and ResultsThis study identified 14,088 adult patients with AMI and severe CS undergoing coronary revascularization from Taiwan’s National Health Insurance Research Database between January 1, 1997 and December 31, 2011, dividing them into the IABP group (n = 7044) and the Nonusers group (n = 7044) after propensity score matching to equalize confounding variables. The primary outcomes included myocardial infarction(MI), cerebrovascular accidents or cardiovascular death. In-hospital events including dialysis, stroke, pneumonia and sepsis were secondary outcomes. Primary outcomes were worse in the IABP group than in the Nonusers group in 1 month (Hazard ratio (HR) = 1.97, 95% confidence interval (CI) = 1.84–2.12). The MI rate was higher in the IABP group (HR = 1.44, 95% CI = 1.16–1.79), and the cardiovascular death was much higher in the IABP group (HR = 2.07, 95% CI = 1.92–2.23). The IABP users had lower incidence of dialysis (8.5% and 9.5%, P = 0.04), stroke (2.6% and 3.8%, P<0.001), pneumonia (13.9% and 16.5%, P<0.001) and sepsis (13.2% and 16%, P<0.001) during hospitalization than Nonusers.ConclusionThe use of IABP in patients with myocardial infarction and severe cardiogenic shock undergoing coronary revascularization did not improve the outcomes of recurrent myocardial infarction and cardiovascular death. However, it did reduce the incidence of dialysis, stroke, pneumonia and sepsis during hospitalization.

The effectiveness of intra-aortic balloon pump for myocardial infarction in patients with or without cardiogenic shock: a meta-analysis and systematic review.

BackgroundConflicting reports on the efficacy of intra-aortic balloon pump (IABP) during percutaneous coronary intervention (PCI) incited us to evaluate the utility of IABP in patients with acute myocardial infarction (AMI).MethodsRandomized clinical trials comparing patients, who received IABP vs. control (no IABP) during PCI, were hand-searched from MEDLINE, Cochrane, and EMBASE databases using the terms “intra-aortic balloon pump, percutaneous coronary intervention, myocardial infarction, acute coronary syndrome”. Mortality rate (30-day and 6-month mortality) was the primary outcome, while the secondary outcomes included 30-day bleeding rate, reinfarction rate, revascularization rate and stroke rate.ResultsPooled results of the seven trials identified indicated that the 30-day and 6-month mortality rate were not significantly different between the IABP and control groups. However, in patients with MI, but without cardiogenic shock (CS), IABP was associated with lower odds of 30-day mortality (OR = 0.35, p = 0.015) and 6-month mortality (OR = 0.41, p = 0.020). The pooled results of 30-day bleeding rate was not significantly higher in patients with IABP than the control group, but for the patients with high risk PCI without CS, it was higher in patients with IABP than the control group (OR = 1.58, p = 0.009). The re-infarction, revascularization, and the stroke rate at 30 days of follow-up were not significantly different between the two groups.ConclusionsThe present results do not favor the clinical utility of IABP in patients suffering high-risk PCI without CS and AMI complicated with CS. However, in patients with AMI, but without CS, IABP may reduce the 30-day and 6-month mortality rate.

Intra-aortic balloon pump combined with mechanical ventilation for treating patients aged > 60 years in cardiogenic shock: Retrospective analysis.

ObjectiveTo examine if mechanical ventilation with positive end-expiratory pressure (PEEP) combined with intra-aortic balloon pump (IABP) provided a better outcome than IABP alone for the treatment of cardiogenic shock after acute myocardial infarction in patients aged > 60 years.MethodsThis was a retrospective analysis of data from patients in cardiogenic shock, refractory to pharmacological therapy and treated at a geriatric coronary care unit.ResultsSixty-two patients were eligible for study inclusion: 33 received IABP alone; 29 received IABP combined with mechanical ventilation. Patients in the IABP + mechanical ventilation group had lower mean arterial blood pressure (BP), systolic BP and partial pressure of oxygen compared with the IABP group, indicating worse cardiac and pulmonary function. In addition, higher rates of pulmonary infection and renal insufficiency were observed in the IABP + mechanical ventilation group than in the IABP group. A statistically significant improvement of left ventricular function before and after treatment was observed in the IABP + mechanical ventilation group, but not in the IABP group. Pulmonary infection and renal insufficiency were risk factors for all-cause in-hospital mortality; successful revascularization was a negative risk factor. There was no between-group difference in survival.ConclusionMechanical ventilation with an appropriate level of PEEP appears to enhance the beneficial effects of IABP on left ventricular function for patients in cardiogenic shock.

The outcomes of intra-aortic balloon pump usage in patients with acute myocardial infarction: a comprehensive meta-analysis of 33 clinical trials and 18,889 patients.

BackgroundThe effects of intra-aortic balloon pump (IABP) usage in patients with acute myocardial infarction remain controversial. This study sought to evaluate the outcomes of IABP usage in these patients.MethodsMedline, EMBASE, and other internet sources were searched for relevant clinical trials. The primary efficacy endpoints (in-hospital, midterm, and long-term mortality) and secondary endpoints (reinfarction, recurrent ischemia, and new heart failure in the hospital) as well as safety endpoints (severe bleeding requiring blood transfusion and stroke in-hospital) were subsequently analyzed.ResultsThirty-three clinical trials involving 18,889 patients were identified. The risk of long-term mortality in patients suffering from acute myocardial infarction was significantly decreased following IABP use (odds ratio [OR] 0.66, 95% confidence interval [CI]: 0.48–0.91, P=0.010). Both in-hospital and midterm mortality did not differ significantly between the IABP use group and no IABP use group (in-hospital: OR 0.87, 95% CI: 0.59–1.28, P=0.479; midterm: OR 1.12, 95% CI: 0.53–2.38, P=0.768). IABP insertion was not associated with the risk reduction of reinfarction, recurrent ischemia, or new heart failure. However, IABP use increased the risk of severe bleeding requiring blood transfusion (OR 2.05, 95% CI: 1.29–3.25, P=0.002) and stroke (OR 1.71, 95% CI: 1.04–2.82, P=0.035). In the thrombolytic therapy and cardiogenic shock subgroups, reduced mortality rates following IABP use were observed.ConclusionIABP insertion is associated with feasible benefits with respect to long-term survival rates in patients suffering from acute myocardial infarction, particularly those suffering from cardiogenic shock and receiving thrombolytic therapy, but at the cost of higher incidence of severe bleeding and stroke.

The Effects of Intra-Aortic Balloon Pumps on Mortality in Patients Undergoing High-Risk Coronary Revascularization: A Meta-Analysis of Randomized Controlled Trials of Coronary Artery Bypass Grafting and Stenting Era.

BackgroundIntra-aortic balloon pumps (IABP) have generally been used for patients undergoing high-risk mechanical coronary revascularization. However, there is still insufficient evidence to determine whether they can improve outcomes in reperfusion therapy patients, mainly by percutaneous coronary intervention (PCI) with stenting or coronary artery bypass graft (CABG). This study was designed to determine the difference between high-risk mechanical coronary revascularization with and without IABPs on mortality, by performing a meta-analysis on randomized controlled trials of the current era.MethodsPubmed and Embase databases were searched from inception to May 2015. Unpublished data were obtained from the investigators. Randomized clinical trials of IABP and non-IABP in high-risk coronary revascularization procedures (PCI or CABG) were included. In the case of PCI procedures, stents should be used in more than 80% of patients. Numbers of events at the short-term and long-term follow-up were extracted.ResultsA total of 12 randomized trials enrolling 2155 patients were included. IABPs did not significantly decrease short-term mortality (relative risk (RR) 0.66; 95% CI, 0.42–1.01), or long-term mortality (RR 0.79; 95% CI, 0.47–1.35), with low heterogeneity across the studies. The findings remained stable in patients with acute myocardial infarction with or without cardiogenic shock. But in high-risk CABG patients, IABP was associated with reduced mortality (71 events in 846 patients; RR 0.40; 95%CI 0.25–0.67).ConclusionIn patients undergoing high-risk coronary revascularization, IABP did not significantly decrease mortality. But high-risk CABG patients may be benefit from IABP. Rigorous criteria should be applied to the use of IABPs.