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

Abstract

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.

Intra-aortic balloon pump postcardiac surgery: A literature review

“…Since IABP clinical benefit is still debated and also there is a controversy between the findings of different studies, physicians, cardiologists, and surgeon should be knowledgeable about the possible factors that interrupt IABC efficacy and this information should be considered in IABP hemodynamic evaluation. [77] As a general rule, the application of IABC in the era of interventional revascularization is highly recommended by many cardiologists and cardiac specialists at high-risk patients. In conclusion, IABP support should be still applied after cardiac surgery in high-risk cohort of patients with postcardiotomy low output syndrome.…”

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

“…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 – 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.…”

“…In 60/75 patients who underwent right heart catheterization in the before-mentioned cohort of Visveswaran, CO and cardiac index increased up to 7 L/min and 3.4 L/min/m 2 respectively, while in the remaining 20% non-responders CO decreased. Remarkably, the mortality rate between responders and non-responders was equal [ 46 ]. In Hsu’s study, all patients showed an initial improvement in CO within the first 24 h, but in patients with adverse events, CO declined after 24–48 h post IABP implantation [ 26 •].…”

“…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].…”

Acute Mechanical Circulatory Support for Cardiogenic Shock

“…The larger-capacity 50 cm 3 IABP provides greater diastolic augmentation and systolic unloading. [8][9][10] Although the femoral artery is commonly used for access, the positive safety profile and feasibility of transthoracic IABPs has been reported by several investigators. 11,12 IABPs can be placed surgically by attaching a Gore-Tex graft to the subclavian or axillary artery.…”