Bedside intra‐aortic balloon pump insertion in cardiac intensive care unit: A single‐center experience

Abstract

Background: In contemporary Cardiac Intensive Care Unit (CICU), bedside intraaortic balloon pump (IABP) insertion under echocardiographic guidance may be an attractive option for selected patients with cardiogenic shock (CS). Currently available data on this approach are limited.Aim: This study aimed to assess the feasibility and safety of bedside IABP insertion, as compared to fluoroscopic-guided insertion in the Catheterization Laboratory (CathLab), and to describe the clinical features of patients receiving bedside IABP insertion using a standardized technique in real-world CICU practice. Methods:We prospectively evaluated all patients admitted the CICU who received transfemoral IABP between June 2020 and October 2021. The overall study cohort was divided according to implant strategy in bedside and CathLab groups. The primary outcome was correct radiographic IABP positioning at the first bedside chest X-ray obtained after insertion. Secondary outcomes included IABP-related complications.Results: Among 115 patients, bedside IABP insertion was performed in 35 (30.4%) cases, mainly presenting with CS-related to acute decompensated heart failure (ADHF) (68.6 vs 33.8%; p < 0.001), with lower LVEF, higher proportion of right ventricular involvement and higher need of inotropes/vasopressors, compared to those receiving CathLab insertion. Bedside IABP insertion resulted feasible and safe, with similar rates of correct IABP positioning (82.9 vs. 82.5%; p = 0.963) and IABP-related major vascular complications (5.7 vs. 5.0%; p = 0.874), as compared to CathLab positioning. Conclusion:This study suggests the feasibility and safety of bedside IABP insertion, which could be of relevant interest in patients with ADHF-related CS who may not need coronary angiography or other urgent CathLab procedures.

Prognostic value of right atrial pressure‐corrected cardiac power index in cardiogenic shock

“…In supported patients, PAC assessment does not reflect native heart CPI but rather native power under inotropic stimulation or the sum of native and MCS power. This limitation was also observed in the first validation study of the CPO, in which 95% of patients were on sympathomimetic amines and 27% on intra‐aortic balloon pump (IABP), and also reflects real‐world practice 10,24 …”

“…They also exhibited an intermediate PAC haemodynamic profile between those in the concordantly high and low groups in terms of CI, MAP, systemic and pulmonary resistances, and LV and RV stroke work. Nevertheless, the discordant group presented features of greater pulmonary overload including the highest PCWP [24 (21, 27) vs. 18 (13,23) vs. 18 (13,25) mmHg; P = 0.016] and highest mean pulmonary artery pressure [mPAP; 40 (32, 45) vs. 29 (22,38) vs. 29 (24,40) mmHg; P = 0.048] and a nominally lower pulmonary artery pulsatility index (PAPi).…”

“…This limitation was also observed in the first validation study of the CPO, in which 95% of patients were on sympathomimetic amines and 27% on intra-aortic balloon pump (IABP), and also reflects realworld practice. 10,24 This drive an inherent bias from the different haemodynamics with vs. without inotropes/MCS in the same patient. Nevertheless, we compared two different formulas with the same variables affected by inotropes/ MCS, the effect of inotropes/MCS is the same in the two calculations, and the additive discriminatory power of the CPI RAP results from the RAP term.…”

Case Report: A 42-year-old male with IABP developing multiple organ embolism and intestinal necrosis

“…Women, advanced age, and peripheral vascular disease are high-risk factors ( 3 ). The most significant drawback of IABP is the occurrence of ischemic vascular complications, primarily resulting from mechanical, thrombotic, or embolic occlusion of aortic branches ( 4 , 5 ). Previous studies have indicated that lower extremity ischemic complications are more prevalent in patients with peripheral vascular disease, with an incidence ranging from 2.6% to 11.7% ( 6 , 7 ).…”