Intra-aortic balloon counterpulsation in cardiogenic shock

Scheidt, Stephen; Wilner, George D.; Mueller, Hiltrud S.; Summers, Donald; Lesch, Michael; Wolff, G; Krakauer, Joseph S.; Rubenfire, Melvyn; Fleming, Peter; Noon, George P.; Oldham, Newland; Killip, Thomas; Kantrowitz, Ádrian

doi:10.1097/00003246-197307000-00010

Cited by 25 publications

(30 citation statements)

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“…29 In theory, the deflation during systole reduces ventricular afterload and helps the ventricle push blood into the aorta, while the inflation during diastole enhances coronary artery perfusion and promotes blood flow to systemic organs. 5 Based on pathophysiological considerations and benefits observed in nonrandomized studies in the pre-PCI era, previous American Heart F I G U R E 3 Forest plots comparing reinfarction, repeat revascularizaton, stroke, acute renal failure, and major bleeding for patients with acute myocardial infarction complicated by cardiogenic shock undergoing IABP insertion before or after primary percutaneous coronary intervention. CI, confidence interval; IABP, intra-aortic balloon pump; PCI, percutaneous coronary intervention Association/American College of Cardiology and European Society of Cardiology guidelines gave the use of IABP a class I recommendation for the management of AMI patients with CS.…”

Section: Discussionmentioning

confidence: 99%

“…3,4 The intra-aortic balloon pump (IABP) becomes the first and most widely used device due to its ability to reduce afterload and improve coronary blood flow. [4][5][6][7] However, recent meta-analyses and the landmark randomized controlled trial did not show a beneficial effect of IABP in patients with AMI complicated by CS. [8][9][10][11] Thus, the recommendations of IABP therapy have been reduced both in the American and European guidelines.…”

Section: Introductionmentioning

confidence: 99%

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Timing of initiation of intra‐aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: A meta‐analysis

Cui

Lyu

Hong

et al. 2019

Clinical Cardiology

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Background For patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS) undergoing primary percutaneous coronary intervention (PCI), the optimal timing of the initiation of intra‐aortic balloon pump (IABP) therapy remains unclear. Therefore, we performed the first meta‐analysis to compare the outcomes of IABP insertion before vs after primary PCI in this population. Methods Electronic databases of PubMed, EMBASE, and Cochrane Library were comprehensively searched from inception to April 1, 2019, to identify the eligible studies. The main outcomes were short‐term (in‐hospital or 30 days) and long‐term (≥ 6 months) mortality. In addition, pooled analysis of risk‐adjusted data were also performed to control for confounding factors. Results Seven observational studies and two sub‐analysis of randomized controlled trials involving 1348 patients were included. Compared to patients inserted IABP after PCI, patients who received IABP therapy before primary PCI had similar risks of short‐term (odds ratio [OR] 0.88, 95% CI 0.49 to 1.59) and long‐term (OR 0.99, 95% CI 0.58 to 1.68) all‐cause mortality. Moreover, a pooled analysis of risk‐adjusted data also found similar effects of the two therapies on short‐term (OR 0.65, 95% CI 0.34 to 1.25) and long‐term (OR 0.68, 95% CI 0.17 to 2.72) mortality. Besides, no significant difference was found between the two groups with respect to reinfarction, repeat revascularization, stroke, renal failure, and major bleeding. Conclusions The timing of the initiation of IABP therapy does not appear to impact short‐term and long‐term survival in patients with AMI complicated by CS undergoing primary PCI.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Timing of initiation of intra‐aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: A meta‐analysis

Cui

Lyu

Hong

et al. 2019

Clinical Cardiology

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“…Treatment strategies in the management of acute cardiogenic shock in ACS are directed at augmenting cardiac output and restoring circulation, and also include an attempt at revascularization of diseased vessel [22], the use of intravenous inotropic/ vasopressor agents, IABP and Impella [23,24]. More recently, percutaneously implanted ventricular assist devices (PVADs), which can be emergently inserted in the cardiac catheterization laboratory, have shown to quickly reverse and stabilize the terminal haemodynamic compromise of severe refractory cardiogenic shock [25].…”

Section: Intensive Care Treatment Strategymentioning

confidence: 99%

Impact and management of left ventricular function on the prognosis of Takotsubo syndrome

El‐Battrawy

Ansari

Lang

et al. 2017

Eur J Clin Investigation

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“…and include a diastolic blood flow augmentation in the coronary and systemic circulation as well as a systolic reduction in resistance to left ventricular ejection (2). Also, a reduction in peak left ventricular wall stress and reduced myocardial oxygen consumption are expected when applied in the acute phase of myocardial infarction.…”

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confidence: 99%

In Vitro Comparison of Support Capabilities of Intra‐Aortic Balloon Pump and Impella 2.5 Left Percutaneous

et al. 2011

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The Impella 2.5 left percutaneous (LP), a relatively new transvalvular assist device, challenges the position of the intra-aortic balloon pump (IABP), which has a long record in supporting patients after myocardial infarction and cardiac surgery. However, while more costly and more demanding in management, the advantages of the Impella 2.5 LP are yet to be established. The aim of this study was to evaluate the benefits of the 40 cc IABP and the Impella 2.5 LP operating at 47,000 rpm in vitro, and compare their circulatory support capabilities in terms of cardiac output, coronary flow, cardiac stroke work, and arterial blood pressure. Clinical scenarios of cardiogenic preshock and cardiogenic shock (CS), with blood pressure depression, lowered cardiac output, and constant heart rate of 80 bpm, were modeled in a model-controlled mock circulation, featuring a systemic, pulmonary, and coronary vascular bed. The ventricles, represented by servomotor-operated piston pumps, included the Frank-Starling mechanism. The systemic circulation was modeled with a flexible tube having close-to-human aortic dimensions and compliance properties. Proximally, it featured a branch mimicking the brachiocephalic arteries and a physiological correct coronary flow model. The rest of the systemic and pulmonary impedance was modeled by four-element Windkessel models. In this system, the enhancement of coronary flow and blood pressure was tested with both support systems under healthy and pathological conditions. Hemodynamic differences between the IABP and the Impella 2.5 LP were small. In our laboratory model, both systems approximately yielded a 10% cardiac output increase and a 10% coronary flow increase. However, since the Impella 2.5 LP provided significantly better left ventricular unloading, the circulatory support capabilities were slightly in favor of the Impella 2.5 LP. On the other hand, pulsatility was enhanced with the IABP and lowered with the Impella 2.5 LP. The support capabilities of both the IABP and the Impella 2.5 LP strongly depended on the simulated hemodynamic conditions. Maximum hemodynamic benefits were achieved when mechanical circulatory support was applied on a simulated scenario of deep CS.

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Intra-aortic balloon counterpulsation in cardiogenic shock

Cited by 25 publications

References 0 publications

Timing of initiation of intra‐aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: A meta‐analysis

Timing of initiation of intra‐aortic balloon pump in patients with acute myocardial infarction complicated by cardiogenic shock: A meta‐analysis

Impact and management of left ventricular function on the prognosis of Takotsubo syndrome

In Vitro Comparison of Support Capabilities of Intra‐Aortic Balloon Pump and Impella 2.5 Left Percutaneous

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