IABP as a Bridge to Decision: A Less Aggressive but Still Effective Approach in Advanced HF Patients with Cardiogenic Shock

Abstract

In this study, we evaluated the effectiveness of Intra-aortic balloon pump (IABP) therapy in improving hemodynamics and peripheral organ function in advanced heart failure (AdHF) patients who were admitted to the Cardiac Intensive Care (CICU) of a tertiary, high-volume, transplant center with impending or established cardiogenic shock.Hundred-four patients were studied their mean age of was 44 ± 12 years, 76 of them (73.08%) were male. All patients underwent IABP therapy. The median time on IABP support for the entire cohort was 13 days (3 -41.25). The survival rate was 87.62% (88 patients). We observed our cohort's significant improvement in the hemodynamics after right heart catheterization with a decrease of the right atrium pressure (p <0. 0001), PA pressure (p<0.001), and pulmonary capillary wedge pressure (p<0.001)). There was also a significant decrease in the NT-proBNP levels (p<0.0001), and improvement in renal function (e GFR (p<0.0001), and urea levels (p<0.001). Sixteen patients (15.38%) ended up in CICU on IABP. We found a significant correlation of death with NT-proBNP levels (p< 0.0014), renal function (p< 0.001), and application of renal dialysis (p< 0.0001), intubation (p<0.006), and with the value of 24-hour lactic acid (p<0.0001).IABP was an effective initial intervention for AdHF patients experiencing severe clinical deterioration. It was a first-line method of managing patients as a bridge to decision for further therapies with positive clinical response in improving their hemodynamics and peripheral organ function.