Complications of Intra-Aortic Balloon Pump Use: Does the Final Position of the IABP Tip Matter?

Abstract

We report results of a retrospective review of intra-aortic balloon pump (IABP) use in two Australasian centres and evaluate the effect of final IABP tip position on outcome. Indications for counterpulsation, patient demographics and in-hospital outcomes and complications were retrospectively collected. The chest X-ray reports provided the 'final' position of the IABP tip. The position was defined as acceptable (tip was seen just below the aortic arch, at T2-T5 vertebrae), malpositioned (tip >5 cm below aortic arch or at T5-T6) or severely malpositioned (tip >10 cm below aortic arch or at T7 or below). Major complications were considered a composite of death secondary to IABP, major limb ischaemia, major IABP malfunction, balloon rupture or haemorrhage, severe renal dysfunction (rise in creatinine >200 µmol/l), stroke and mesenteric ischaemia. Six hundred and forty-five cases were reviewed. The overall major complication rate was 26.2% and 24.3%. Severe renal impairment was the most common complication (16.6%), and second, severe catheter dysfunction (5.4%). Final IABP position was acceptable in 39.9%, malpositioned in 11.1%, severely malpositioned in 6.7% and unavailable for 42.4%. Logistic regression analysis showed IABP tip malposition (compared with satisfactory position odds ratio=3.9 [95% confidence interval=2.0-7.6, P <0.001] and severely malpositioned odds ratio=13.0 [95% confidence interval=5.3-31.7, P <0.001]) were associated with major complications more than the presence of shock (odds ratio=3.8, confidence interval 2.1-6.8 P <0.001). The acceptance of a less than ideal final position was highly predictive of morbidity directly related to IABP device therapy.

Complications of Temporary Percutaneous Mechanical Circulatory Support for Cardiogenic Shock: An Appraisal of Contemporary Literature

“…Studies of IABP to support PCI report bleeding rates of 3.3–8.4% [53–55]. More recent studies of IABP for AMI, CS, UA, and perioperative use report rates from 0.8 to 26.3% [33–35, 37, 39, 41, 56–60]. Bleeding rates for Impella ® are poorly described, but range from as low as 0.05% to 54% when inserted percutaneously [21, 44, 61–64].…”

“…Therefore, the assessment of neurological injury and development of CVA is complex in this population. CVA rate in IABP is typically low, 1–10% [35, 39, 42, 49, 52, 53, 55, 56, 58, 74, 75, 91]. Impella ® and TandemHeart ® have rates similar to IABP, reported from 2.4 to 6.3% [29, 65, 66, 82, 88].…”

“…The rate of limb ischemia for IABP insertion demonstrates wide variations in the literature: 0.03 to 42% [33–35, 42, 46, 48, 55, 57, 58, 73, 80, 91, 99, 100, 102, 109–111], however, more recent studies show lower rates of 0.9–12% [30, 39, 41, 75]. This can partly be attributed to improvements in sheath size, better patient selection, and shorter durations of support.…”

Left Ventricular Assisting Devices in Percutaneous Coronary Intervention

“…The acceptance of less-ideal placement of the balloon was indicative of the morbidity of the patient in most cases. 9 The primary complication is arterial damage from the catheter; however, ischemia of the limbs, thrombosis, renal failure, balloon leaks, vessel perforations, and bleeding are all possible complications that can arise. There are several recent studies done to show the effectiveness of the IABP.…”

Predictive Modeling for Nonocclusive Mesenteric Ischemia

“…One study looking at IABP positioning showed a 13-fold increased risk of major complications, including renal failure and mesenteric ischemia, compared to a properly positioned IABP. 8 Although not mentioned in their study, hopefully the authors corrected IABP malposition (or even removed it), which should be demonstrated on postoperative radiologic exams.…”