Intra-aortic Balloon Pump For Treatment Research Articles

Left ventricular assist device versus intra-aortic balloon pump for treatment of acute myocardial infarction complicated by cardiogenic shock: a systematic review and meta-analysis

Abstract Background 1. Despite early revascularization, the mortality of patients with acute myocardial infarction complicated by cardiogenic shock (AMI-CS) remains high. 2. Mechanical circulation support devices (MCS) are widely utilized in clinical due to unloading left ventricle and augmenting cardiac output. 3. Whether left ventricular assist device (LVAD) including TandemHeart and Impella is superior to Intra-aortic balloon pump (IABP) for AMI-CS remains unclear. Aim To investigate the efficacy and safety of LVAD versus IABP for AMI-CS. Methods 1. We searched the relevant literature on PUBMED, EMBASE and Cochrane Library. 2. The primary endpoint was 30-day mortality. The secondary endpoints were in-hospital myocardial infarction (MI), stent thrombosis (ST), stroke, sepsis, major bleeding and limb ischemia. 3. Two investigators performed the studies selection and data extraction independently. 4. The quality of randomized controlled trials and observational studies was assessed by using the Cochrane Collaboration's tool and Newcastle-Ottawa Scale respectively. 5. Results were analyzed by computing pooled risk ratios (RR) with 95% Confidence Intervals (CIs). Results 1. The process of literature search strategy is shown in Figure 1. 2. Main characteristics of the included studies can be seen in Table 1. 3. There was no significant difference in 30-day mortality (RR:0.97, 95% CI:0.80–1.17, P=0.76), in-hospital MI (RR:0.64, 95% CI:0.22–1.85, P=0.41), ST (RR:0.74, 95% CI:0.13–4.12, P=0.73), stroke (RR:1.36, 95% CI:0.37–4.94, P=0.64) and sepsis (RR:1.30, 95% CI:0.54–3.13, P=0.56) between LVAD and IABP group. However, the incidences of in-hospital major bleeding (RR:2.61,95% CI:1.61–4.23, P=0.0001) and limb ischemia (RR:4.91, 95% CI:2.07–11.64, P=0.0003) were significantly higher in LVAD than IABP group. Conclusion LVAD was not associated with reduced 30-day mortality but with increased in-hospital major bleeding and limb ischemia for patients with AMI-CS compared with IABP. Figure 1 Funding Acknowledgement Type of funding source: Public Institution(s). Main funding source(s): National 135 Key Research and Development Program in 2016

Usefulness of Intra-aortic Balloon Pump in Patients With Cardiogenic Shock

Predictors of survival in cardiogenic shock (CS) treated with intra-aortic balloon pump (IABP) are not clearly understood. In this retrospective study, we sought to evaluate patient characteristics and impact of timing of IABP in treatment of CS. Patients presenting to the Yale New Haven Hospital in CS who received IABP between February 2013 and April 2017 were included in the study. We assessed baseline characteristics and clinical predictors of 30-day mortality. Hundred ninety-three (n = 193) patients were included in this study. Mean age was 68.8 ± 14.5 years. Thirty percent (30%) were women, 38% had cardiac arrest, and left ventricular ejection fraction was 33.7 ± 14.9%. Overall 30-day mortality was 36%. Thirty-day mortality was 24% when IABP was placed within less than 1 hour of onset of CS versus 49% when implanted ≥1 hour after recognition of CS (p = 0.001). Mortality was 18%, 21%, 36%, and 74% for patient requiring 0, 1, 2, and 3 or more inotropes after IABP placement (p < 0.001). In multivariate analysis, advancing age, cardiac arrest on presentation, time to IABP implantation, and number of inotropes needed after IABP implantation predicted 30-day mortality. In the 193 patients, 134 (69.4%) presented with CS from ACS and 59 (30.6%) with CS from non-ACS-related causes. No difference in mortality was noted between the ACS and non-ACS groups 34.3% versus 40.7% (p = 0.39). In conclusion, early use of IABP in CS was associated with significant improvement in 30-day mortality regardless of the etiology of CS. Continued need for significant inotropic support after IABP is associated with worse prognosis and maybe used as an indicator for need to escalate to higher levels of support.

P2481Impella assist device or intraaortic balloon pump for treatment of cardiogenic shock due to acute coronary syndrome

P2481Impella assist device or intraaortic balloon pump for treatment of cardiogenic shock due to acute coronary syndrome

Intra-aortic balloon pump for treatment of refractory ventricular tachycardia in Tako-Tsubo cardiomyopathy: A case report

Tako-Tsubo cardiomyopathy (TTC) is characterized by a transient dysfunction of the left ventricular apex, often triggered by emotional or physical stress. Estimated prevalence of TTC ranges from 0.1 to 2.2% of patients with acute coronary syndrome (ACS). It usually occurs in old postmenopausal women. It often presents with chest pain and ECG changes (ST elevation in precordial leads and subsequent T wave inversion) and minimal myocardial enzymatic elevation which could mimic ACS, but in absence of coronary artery disease.

Methods of cardiopulmonary support: a review for radiologists.

Physicians are generally aware of the use of bypass pumps during open heart surgery and of the intraaortic balloon pump in treatment of cardiogenic shock. In selected research centers, other advanced methods of cardiopulmonary support are being introduced. Some devices such as the total artificial heart fail clinical trials and disappear from use. Others, like some of the partial artificial hearts, improve outcomes and gain wider clinical use. Some devices temporarily support the circulation in patients recovering from acute circulatory collapse, whereas others provide longer-term circulatory support for patients awaiting transplantation. Permanently implanted devices provide circulatory assistance in cases of chronic, debilitating heart failure. Technology to support lung function in the setting of acute respiratory failure, allowing healing to take place, is also under study. Radiologists should be familiar with the operating principles and radiographic appearances of these emerging techniques to maintain their role as consultants to cardiopulmonary specialists.