A single center tertiary care experience utilizing the large volume mega 50cc intra‐aortic balloon counterpulsation in contemporary clinical practice

Visveswaran, Gautam; Cohen, Marc; Seliem, Ahmed; DiVita, Michael; McNamara, Jonathan K. R.; Dave, Amar; Wasty, Najam; Baran, David A.

doi:10.1002/ccd.26908

Cited by 11 publications

(13 citation statements)

References 17 publications

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“…This study along with the prior work on the 50 cc IAB catheter provide an evidence base for rational use of the IABC when managing cardiogenic shock. In our center, the institutional practice has been to utilize an IABC as the first line of percutaneous mechanical circulatory support for patients failing inotropic support who do not have an obvious need for higher levels of support such as extracorporeal membrane oxygenation.…”

Section: Discussionmentioning

confidence: 85%

“…Recently, we reported a single center series of patients undergoing hemodynamic support with a 50 cc intra‐aortic balloon pump catheter (MEGA 50, Maquet). A total of 150 patients were studied and the outcomes including complications were described in detail . A subset (76 patients) had a right heart catheter placed at the time of IABC insertion as well as follow‐up hemodynamics and this analysis focuses on these patients.…”

Section: Introductionmentioning

confidence: 99%

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Differential responses to larger volume intra‐aortic balloon counterpulsation: Hemodynamic and clinical outcomes

Baran

Visveswaran

Seliem

et al. 2017

Cathet Cardio Intervent

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ObjectivesExamine hemodynamic and clinical correlates of use of an intra‐aortic balloon pump catheter in a single center.BackgroundThe intra‐aortic balloon pump catheter (IABC) has been used for 50 years but the clinical benefit is still debated. We reviewed 76 patients with right heart catheter measurements prior to IABC to assess response and outcomes.MethodsAll patients who received IABC with a 50cc balloon for at least 1 hour were included in this retrospective chart review study. Demographics, comorbidities, lab values, and hemodynamic parameters were recorded at baseline and 15 h postinsertion.ResultsSeventy‐six patients had paired measurements of cardiac output. 60 patients had a higher cardiac output with IABC treatment (responder group) and 16 did not (nonresponders). In the 60 patients in the responder group, cardiac output and index significantly increased from baseline 3.6 ± 1.3 L/min to 5.2 ± 1.8 L/min, and 1.8 ± 0.5 L/min/m2 to 2.6 ± 0.8 L/min/m2 respectively following IABC placement (P < 0.0001 for both comparisons). Various hemodynamic variables were examined and the best predictor of response to IABC was a cardiac power index of 0.3 or less. Regardless of response, in hospital survival was similar between groups.ConclusionsThe majority of patients improve their cardiac output with IABC but survival was unchanged. Further work into the pathophysiology of cardiogenic shock is needed.

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Section: Discussionmentioning

confidence: 85%

Section: Introductionmentioning

confidence: 99%

Differential responses to larger volume intra‐aortic balloon counterpulsation: Hemodynamic and clinical outcomes

Baran

Visveswaran

Seliem

et al. 2017

Cathet Cardio Intervent

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“…Data were collected from a prospective internal registry of patients who had a Maquet® (Rastatt, Germany) 8-French Mega 50 cc IABP placed in the axillary artery position in 46 consecutive patients [ 3 ]. A majority of these devices were placed for acute decompensated congestive heart failure deemed to require mechanical circulatory support based on hemodynamic indices and used as a bridge to recovery or destination therapy.…”

Section: Methodsmentioning

confidence: 99%

Efficacy of Manual Hemostasis for Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal

Tayal

DiVita

Sossou

et al. 2020

Journal of Interventional Cardiology

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Background. The prevalence of peripheral vascular disease has led to the re-emergence of percutaneous axillary vascular access as a suitable alternative access site to femoral artery. We sought to investigate the efficacy and safety of manual hemostasis in the axillary artery. Methods. Data were collected from a prospective internal registry of patients who had a Maquet® (Rastatt, Germany) Mega 50 cc intra-aortic balloon pumps (IABP) placed in the axillary artery position. They were anticoagulated with weight-based intravenous heparin to maintain an activated partial thromboplastin time (aPTT) of 50–80 seconds. Anticoagulation was discontinued 2 hours prior to the device explantation. Manual compression was used to achieve the hemostasis of the axillary artery. Vascular and bleeding complications attributable to manual hemostasis were classified based on the Valve Academic Research Consortium-2 (VARC-2) and Bleeding Academic Research Consortium-2 (BARC-2) classifications, respectively. Results. 29 of 46 patients (63%) achieved axillary artery homeostasis via manual compression. The median duration of IABP implantation was 12 days (range 1–54 days). Median compression time was 20 minutes (range 5–60 minutes). There were no major vascular or bleeding complications as defined by the VARC-2 and BARC-2 criteria, respectively. Conclusion. Manual compression of the axillary artery appears to be an effective and safe method for achieving hemostasis. Large prospective randomized control trials may be needed to corroborate these findings.

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“…The magnitude of systolic unloading correlated directly with the magnitude of diastolic augmentation and inversely with the PA occlusion pressure [44]. Also in later studies, 50-cc IABP caused significant diastolic pressure augmentation (Δ + 42 mmHg), systolic unloading (Δ − 15 mmHg), increased CO (Δ + 1.03 L/min), and decreased cardiac filling pressures in the majority of patients [45,46].…”

Section: Large-volume Iabp May Be Bettermentioning

confidence: 96%

“…The hemodynamic effects of an IABP stand out better with larger balloon size. Several recent studies demonstrate that the use of larger 50-cc balloons resulted in a greater reduction in cardiac filling pressures and increased CO compared with the 40-cc IABPs [44][45][46]. Unfortunately, 50-cc IABPs were generally not used in the major landmark studies so far, since the 50-cc IABP was only introduced in 2012.…”

Section: Non-acs Cardiogenic Shockmentioning

confidence: 99%

Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

Kimman

Mieghem

Endeman

et al. 2020

Curr Heart Fail Rep

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Purpose of Review We aim to summarize recent insights and provide an up-to-date overview on the role of intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS). Recent Findings In the largest randomized controlled trial (RCT) of patients with CS after acute myocardial infarction (AMICS), IABP did not lower mortality. However, recent data suggest a role for IABP in patients who have persistent ischemia after revascularization. Moreover, in the growing population of CS not caused by acute coronary syndrome (ACS), multiple retrospective studies and one small RCT report on significant hemodynamic improvement following (early) initiation of IABP support, which allowed bridging of most patients to recovery or definitive therapies like heart transplant or a left ventricular assist device (LVAD). Summary Routine use of IABP in patients with AMICS is not recommended, but many patients with CS either from ischemic or non-ischemic cause may benefit from IABP at least for hemodynamic improvement in the short term. There is a need for a larger RCT regarding the role of IABP in selected patients with ACS, as well as in patients with non-ACS CS.

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A single center tertiary care experience utilizing the large volume mega 50cc intra‐aortic balloon counterpulsation in contemporary clinical practice

Cited by 11 publications

References 17 publications

Differential responses to larger volume intra‐aortic balloon counterpulsation: Hemodynamic and clinical outcomes

Differential responses to larger volume intra‐aortic balloon counterpulsation: Hemodynamic and clinical outcomes

Efficacy of Manual Hemostasis for Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal

Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

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