Percutaneous intraaortic balloon insertion

Bregman, David; Nichols, Allen B.; Weiss, Melvin B.; Powers, Eric R.; Martin, Eric C.; Casarella, William J.

doi:10.1016/0002-9149(80)90067-3

Cited by 103 publications

(20 citation statements)

References 11 publications

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“…8 Percutaneous insertion was described by Bregman et al in 1980, allowing for widespread use. 9 Thrombocytopenia has long been known to be an adverse effect of IABP, but the published literature on this topic is quite limited. 1 -3,5 The 2 most recently published studies, reported 10 years apart, yielded remarkably similar results using the same definition of thrombocytopenia as the present analysis.…”

Section: Discussionmentioning

confidence: 99%

Clinical Implications of Thrombocytopenia Among Patients Undergoing Intra‐aortic Balloon Pump Counterpulsation in the Coronary Care Unit

Roy

Howard

Panza

et al. 2010

Clinical Cardiology

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Background: Thrombocytopenia Hypothesis: intra-aortic balloon pump (IABP)-associated thrombocytopenia is not associated with an increased risk of major bleeding or in-hospital death. Thrombocytopenia is a common adverse effect of the IABP. However, the clinical implications of IABP-associated thrombocytopenia are unknown. Methods: We assessed the incidence and predictors of thrombocytopenia, and the association between thrombocytopenia and relevant clinical end points, using prospectively collected data on 252 consecutive patients undergoing IABP in a single coronary care unit (CCU). Results: Anticoagulation with intravenous heparin was administered to 182 patients (72%). Baseline platelet counts were 232 000 ± 96 000 mL, decreased to 154 000 ± 74 000 mL at day 3, and recovered to baseline by day 8. Thrombocytopenia (nadir <150 000 mL or >50% reduction from baseline) occurred in 109 patients (43%), with a similar incidence among patients who received heparin and those who did not (45% vs 40%, P = 0.5). Independent predictors of thrombocytopenia were lower body weight, cardiogenic shock, and duration of IABP support. The incidence of both major bleeding and in-hospital death were higher among patients who developed thrombocytopenia than among those who did not (13.8% vs 4.2%, P = 0.01 and 28% vs 16%, P = 0.02, respectively). However, after controlling for confounding variables, thrombocytopenia was not an independent predictor of either major bleeding (odds ratio [OR]: 2.2, 95% confidence interval [CI]: 0.8-6.4, P = 0.1) or in-hospital death (OR: 1.5, 95% CI: 0.8-2.9, P = 0.3). Conclusions: Among patients undergoing IABP in the CCU, thrombocytopenia is generally mild, appears to be unrelated to concomitant heparin use, and is not associated with an increased risk of major bleeding or in-hospital death.

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Section: Discussionmentioning

confidence: 99%

Clinical Implications of Thrombocytopenia Among Patients Undergoing Intra‐aortic Balloon Pump Counterpulsation in the Coronary Care Unit

Roy

Howard

Panza

et al. 2010

Clinical Cardiology

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“…Percutaneous delivery and improving catheter design and operator experience has precluded the need for femoral arteriotomy and greatly reduced the incidence of vascular complications over time. 8 Complication rates, however, are difficult to determine because of varying definitions, indications for and duration of insertion (Tables 1 and 2). …”

Section: Physiological and Hemodynamic Effectsmentioning

confidence: 99%

Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention

Patterson

Perera

Redwood

2014

Circ: Cardiovascular Interventions

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Interestingly, the International Benchmark Registry (250 US and non-US centers) of over 20 000 patients treated with IABP suggested that 1 in 5 cases of IABP implantation were for CS and 1 in 5 as an adjunct to high-risk PCI. 11 In the context of AMI, IABP was used more frequently during CS (30%) or an adjunct to PCI (30%).10 Analysis of the CathPCI Registry from the National Cardiovascular Data Registry of patients who underwent high-risk PCI (10% in CS and 80% ST-segmentelevation myocardial infarction [STEMI]) with and without the use of IABP found IABP use was slightly less-10% of (Circ Cardiovasc Interv. 2014;7:712-720.) © 2014 American Heart Association, Inc. Post-MI and Cardiogenic ShockAMI is complicated by CS in ≈5% to 10% of cases. Although death from AMI has decreased with aggressive primary prevention and after wide-scale institution of early urgent revascularization, the incidence of CS after MI remains unchanged. 25The presence of CS is a major adverse prognostic factor and still the most common cause of hospital mortality (60%-70%) associated with AMI. 26 In addition to revascularization, optimal drug therapy, vasopressor, and inotropic support, IABP is the most commonly used mechanical support device to maintain hemodynamic stability in an attempt to improve clinical outcome. The evidence for the use of IABP as an adjunct to PCI in post-MI CS is controversial. A recent meta-analysis of registry data showed no benefit from the use of IABP in CS with regard to 30-day mortality independent of reperfusion strategy, which led to the recent downgrading of the American Heart Association guidelines on hemodynamic support in post-MI CS from a Class I recommendation to Class IIB. [27][28][29] Early use of IABP in post-MI CS was based predominantly on small nonrandomized retrospective studies. In the thrombolytic era, concomitant IABP in the presence of recombinant-tissue plasminogen activator was thought to enhance thrombolysis through augmentation of perfusion pressure and was associated with a reduction in in-hospital and 1-year mortality when compared with thrombolysis alone. 30,31 In the late 1990s, the multicenter randomized Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock (SHOCK) trial showed a benefit to short-, medium-, and longterm survival incurred by early revascularization post-MI complicated by CS. 32 The Thrombolysis and Counterpulsation to Improve Survival in Myocardial Infarction Complicated by Hypotension and Suspected Cardiogenic Shock (TACTICS) randomized trial of IABP-assisted thrombolysis in post-MI CS did not reach its primary end point of improved 6-month survival, but there was trend to increased survival with IABP in patients with significant heart failure. 33 One interpretation is that thrombolysis is an inferior reperfusion strategy, and this may explain why no benefit has been definitively shown with IABP after primary PCI. A meta-analysis of IABP use in patients with AMI showed no effect on outcome; however, in the subset of AMI and CS, there was si...

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“…Diese Entwicklung ist zum einen darauf zurª252 dal3 zunehmend neue interventionelle Verfahren bei der Behandlung des akuten Myokardinfarkts zum Einsatz kommen, zum anderen ist die Anwendung der IABP zuletzt wesentlich praktikabler geworden. Durch die Einfª der perkutanen Implantation mittels modifizierter SeldingerTechnik zu Beginn der 80er Jahre [6] und durch die Verbesserung des Kathetermaterials mit Reduktion der Katheterdicke von anfangs 14 F auf zuletzt 8,0 F (wahlweise schleusenlose Implantationstechnik [43]) ist heute die Plazierung des IABP-Katheters ein einfaches, schnelles und sicheres Verfahren geworden, wodurch der rasche Einsatz der IABP vor allem auch in Notfallsituationen mtiglich ist. Die Implantation des Ballons gelingt mit der perkutanen Technik nach Literaturangaben bei weit ª 90% der Patienten [56]; im eigenen Kollektiv war eine korrekte Plazierung sogar bei 373 von 381 konsekutiven Patienten (97,9%) m6glich [71].…”

Section: Klinische Ergebnisse Der Iabp: Die Erste Klinischeunclassified

Reperfusionstherapie und mechanische Kreislauf-unterstützung bei Patienten mit kardiogenem Schock

Scholz

1999

Herz

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Cardiogenic shock is a state of inadequate tissue perfusion due to cardiac dysfunction, which is most commonly caused by acute myocardial infarction. The pathophysiology of cardiogenic shock is characterized by a downward spiral: ischemia causes myocardial dysfunction, which, in turn, augments the ischemic damage and the energetical imbalance. With conservative therapy, mortality rates for patients with cardiogenic shock are frustratingly high reaching more than 80%. Additional thrombolytic therapy has not been shown to significantly improve survival in such patients. Emergency cardiac catheterization and coronary angioplasty, however, seem to improve the outcome in shock-patients, which most probably is due to rapid and complete revascularization generally reached by angioplasty. In addition to interventional therapy with rapid coronary revascularization, the use of mechanical circulatory support may interrupt the vicious cycle in cardiogenic shock by stabilizing hemodynamics and the metabolic situation. Different cardiac assist devices are available for cardiologists and cardiac surgeons: 1. intraaortic balloon counterpulsation (IABP), 2. implantable turbine-pump (Hemopump), 3. percutaneous cardiopulmonary bypass support (CPS), 4. right heart, left heart, or biventricular assist devices placed by thoracotomy, and 5. intra- and extrathoracic total artificial hearts. Since percutaneous application is possible with IABP, Hemopump and CPS, these devices are currently used in interventional cardiology. The basic goals of the less invasive intraaortic balloon counterpulsation (IABP; Figure 1) are to stabilize circulatory collapse, to increase coronary perfusion and myocardial oxygen supply, and to decrease left ventricular workload and myocardial oxygen demand (Figure 2). Since the advent of percutaneous placement, IABP has been used by an increasing number of institutions (Figure 3). In addition to cardiogenic shock, the system may be of use in a variety of other indications in the catheterization laboratory and intensive care unit, including weaning from percutaneous cardiopulmonary bypass, in ischaemic left ventricular failure, in unstable angina, in high risk PTCA, and in prophylactic support in patients with myocardial infarction and successful revascularization. Animal experimental data showed that IABP may improve success of thrombolysis and recent clinical data suggest that survival is enhanced and transfer for revascularization is facilitated when patients with myocardial infarction and cardiogenic shock undergo thrombolysis and IABP rather than thrombolysis alone. A lot of studies had demonstrated before, that combined use of counterpulsation and revascularization therapy (i.e. coronary bypass surgery or angioplasty) may improve prognosis in patients with myocardial infarction complicated by cardiogenic shock (Table 1). In such patients, early treatment with IABP is most important: Multivariate analysis identified early IABP-support with a duration of shock to IABP-treatment of > or = 4 hours as an independ...

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Percutaneous intraaortic balloon insertion

Cited by 103 publications

References 11 publications

Clinical Implications of Thrombocytopenia Among Patients Undergoing Intra‐aortic Balloon Pump Counterpulsation in the Coronary Care Unit

Clinical Implications of Thrombocytopenia Among Patients Undergoing Intra‐aortic Balloon Pump Counterpulsation in the Coronary Care Unit

Intra-Aortic Balloon Pump for High-Risk Percutaneous Coronary Intervention

Reperfusionstherapie und mechanische Kreislauf-unterstützung bei Patienten mit kardiogenem Schock

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