Intra-aortic balloon assistance in cardiogenic shock after myocardial infarction or cardiac surgery.

Abstract

Sixty-eight patients were referred for consideration of intra-aortic balloon assistance, 55 of whom were accepted. Thirty-one patients were in cardiogenic shock after myocardial infarction and the remaining 24 were cardiac surgical patients. Twenty-three of the myocardial infarct group were established on IABA and all 24 of the cardiac surgical patients. Of the 23 patients with cardiogenic shock after myocardial infarction, 19 showed initial haemodynamic improvement on intra-aortic balloon assistance and 5 (22%) survived to leave hospital. Of the 24 cardiac surgical patients, 15 could not be withdrawn from total cardiopulmonary bypass. With intra-aortic balloon assistance, 11 (73%) could be withdrawn from cardiopulmonary bypass and 5 (33%) were hospital and long-term survivors. The remaining 9 surgical patients were in cardiogenic shock in the early postoperative phase, though 5 showed initial haemodynamic improvement there was only one hospital survivor in this group. Intra-aortic balloon assistance was, therefore, of most value in patients dependent on cardiopulmonary bypass. The survyival in patients with cardiogenic shock after myocardial infarction was marginally improved.

Intraaortic Balloon Counterpulsation: A Review

“…Using the IABP in patients with acute myocardial infarction with complications, such as cardiogenic shock, without any subsequent plan for surgery, has been shown to be less valuable. In a review of balloon pumping in 401 patients for cardiogenic shock who did not undergo surgery, the overall survival was 28% (113/401) with a range of 11 to 71%.4-14 In 24 recent studies in the literature, 1543 IABP patients treated both medically and surgically had an overall hospital survival of 50% (776/1543).4° 11-~3~ [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34] Most authors stressed the importance of early IABP in the treatment of cardiogenic shock and also pointed out better results in surgically managed cardiac patients, both pre-and postoperatively.…”

Choque cardiogénico: de la definición al abordaje

“…Por ende, se puede definir como un estado en el cual el GC es ineficiente para perfundir y oxigenar los tejidos, y manifestarse con signos de hipoperfusión tisular pese a un adecuado estado de volumen intravascular. 3,4 De manera más objetiva, existen criterios reconocidos desde hace más de 40 años 5 que han sido modificados ligeramente a lo largo del tiempo, empleados en distintos estudios de referencia [6][7][8][9][10][11] y plasmados en las últimas guías clínicas 4 (Tabla 1).…”

“…Antes de 1980 5,12 Estudio SHOCK (1999) 6 Guías ESC falla cardiaca (2016) 4 Pico arterial sistólico < 90 mm Hg confirmado por canulación arterial Signos/síntomas de colapso circulatorio: Taquicardia sinusal, presión de pulso reducida, cianosis, ansiedad, sed, piel fría, estupor o coma, flujo urinario < 20 mL/h Presión en cuña ≥ 18 mmHg Criterios clínicos:…”

“…Por lo general se moviliza entre 30-50 mL de sangre durante este proceso, por lo que aumenta el GC y la perfusión sistémica. 5,23 El éxito de esta terapia reside en la relación de tiempo entre inflado y desinflado (por ejemplo 1:2, 1:4), el cual puede manipularse a través de una consola. Esta consola se sincroniza por registro electrocardiográfico o mediante la onda de presión arterial.…”

Arterial counterpulsation in continuing myocardial ischaemia after acute myocardial infarction.

“…Apart from use in surgical patients, the principal application has been at the two extreme ends of the spectrum of acute infarction-in patients with cardiogenic shock on the one hand (Dunkman et al, 1972;Scheidt et al, 1973;Jackson et al, 1977) and in patients with threatening infarction or coronary insufficiency on the other (Mundth, 1976;Leinbach et al, 1978). Despite the use of counterpulsation, mortality rate has remained high in cardiogenic shock and low in coronary insufficiency.…”