Intra-aortic balloon pumps in cardiogenic shock: an overview

2021 ◽  
pp. 1-11
Author(s):  
Kate O'Donovan
Keyword(s):  
Cardiogenic Shock ◽  
Left Subclavian Artery ◽  
Insertion Site ◽  
Circulatory Support ◽  
Coronary Perfusion ◽  
Limb Ischaemia ◽  
Intra Aortic Balloon Pump ◽  
Catheter Size ◽  
Specialist Knowledge ◽  
St Elevation

The intra-aortic balloon pump was first introduced for the treatment of cardiogenic shock. It is now the most commonly used form of circulatory support, despite disappointing findings from the intra-aortic balloon pump SHOCK II trial ( Thiele et al, 2012 ). Common placement is via the femoral artery into the aorta, with the tip of the balloon sitting below the left subclavian artery and the distal end above the renal arteries. The balloon is timed to inflate at the beginning of diastole augmenting coronary perfusion and deflate on the R wave just before systole, reducing the afterload. Patients who may be considered for intra-aortic balloon pump insertion are those experiencing ST elevation myocardial infarction or complex ischaemic disease and cardiogenic shock. Despite advances in catheter size and technology, potential complications include bleeding from the insertion site, limb ischaemia and compartment syndrome. Cardiovascular nurses require specialist knowledge and skills concerning balloon console technology, nursing care and potential complications.

scholarly journals Intra-aortic Balloon Pump Therapy for Anterior ST-elevation Myocardial Infarction with Cardiogenic Shock: An Observational Cohort Study

2019 ◽  
Author(s):  
Kuo Zhou ◽  
Shuzheng Lyu ◽  
Jing Dai ◽  
Jinfan Tian ◽  
Kongyong Cui ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Lower Limb ◽  
Cox Regression ◽  
Anterior Wall ◽  
St Elevation Myocardial Infarction ◽  
Rank Test ◽  
Control Group ◽  
Intra Aortic Balloon Pump ◽  
St Elevation

Abstract Background As a mechanical circulatory assistance, intra-aortic balloon pump (IABP) has been widely used for cardiogenic shock (CS), although recent clinical trials questioned its impact on acute myocardial infarction patients, nothing is hitherto known on the contribution of IABP to CS patients after anterior wall infarction. The aim of this study was to investigate the efficacy and safety of IABP therapy in patients presenting with anterior ST-elevation myocardial infarction (STEMI) complicated by CS.Methods We conducted a retrospective study of 215 consecutive patients presenting with CS after STEMI in the anterior wall between January 2006 and August 2017, including 125 patients in the IABP group and 90 patients in the control group.Results At 30 days, 60 (48.0%) patients in the IABP group and 58 (64.4%) patients in the control group had died (P=0.017). The Kaplan-Meier survival curves showed the cumulative survival rate in the IABP group was consistently higher than control group (P=0.009 by Log-Rank test). Nevertheless, IABP increased the occurrence of thrombocytopenia (21.6% vs. 2.2%, P<0.001) and lower limb complications (20.0% vs. 2.2%, P<0.001) at the same time. Subgroup analyses by Cox regression showed a better trend of prognoses in patients aged less than 60 years old (HR=0.49, 95% CI=0.26-0.91, P=0.025), male (HR=0.53, 95% CI=0.34-0.83, P=0.005), no history of hypertension (HR=0.47, 95% CI=0.26-0.87, P=0.017) and systolic blood pressure less than 80 mm Hg (HR=0.40, 95% CI=0.22-0.73, P=0.009). At 12-month follow-up, all-cause mortality in the IABP group was obviously lower than the control group (52.5% vs. 74.1%, P=0.002), there were no significant differences in other adverse cardiovascular events (P=1.000).Conclusions The combination of IABP use is associated with reduced 30-day and 12-month mortality in patients with anterior STEMI complicated by CS, though thrombocytopenia and lower limb complications are frequently observed.

Intra-aortic balloon pump versus percutaneous Impella© in emergency revascularisation for myocardial infarction and cardiogenic shock: systematic review

Perfusion ◽  
2021 ◽  
pp. 026765912110370
Author(s):  
Kristina Frain ◽  
Paul Rees
Keyword(s):  
Myocardial Infarction ◽  
Systematic Review ◽  
Cardiogenic Shock ◽  
Survival Rates ◽  
Circulatory Support ◽  
Future Research ◽  
Eligibility Criteria ◽  
Intra Aortic Balloon Pump ◽  
Mesh Terms ◽  
Randomised Controlled

Objectives: Mortality rates in patients with acute myocardial infarction and cardiogenic shock (AMI-CS) remain persistently high despite advances over the past decade in percutaneous mechanical circulatory support. This systematic review aims to analyse the existing literature to compare mortality outcomes in patients mechanically supported by intra-aortic balloon pump or percutaneous Impella 2.5/CP© for AMI-CS undergoing emergency revascularisation. Methods: The following MeSH terms were applied to the databases Ovid Medline, Ovid Embase, Cochrane and Web of Science: ‘Intra-aortic balloon pump’, ‘Impella’, ‘Cardiogenic shock’, ‘Myocardial Infarction’ and ‘Mortality’. This yielded 2643 studies. Using predefined inclusion and exclusion criteria, the studies were initially screened by title and abstract before full text analysis. Results: Fourteen studies met eligibility criteria: two randomised controlled trials (RCTs) and 12 observational studies. Data from a total of 21,006 patients were included across the studies. Notably, one study claimed reduced mortality with IABP versus control, and one study concluded that Impella© improved survival rates over the IABP. The average 30-day all-cause mortality in patients supported by IABP was 38.1%, 54.3% in Impella© groups and 39.4% in control groups. Conclusion: AMI-CS presents an important cohort of patients in whom conducting RCTs is difficult. As a result, the literature is limited. Analysis of the available literature suggests that there is insufficient evidence to support superior survival in those supported by IABP or Impella© when compared to control despite suggestions that the Impella© offers superior haemodynamic support. Limitations of the studies have been discussed to outline suggestions for future research.

scholarly journals Cardiogenic Shock Due to ST Elevation Myocardial Infarction: How Far Are We?

2021 ◽  
Vol 01 (01) ◽  
pp. 003-0010
Author(s):  
Rohit Mody
Keyword(s):  
Myocardial Infarction ◽  
Cardiogenic Shock ◽  
Hemodynamic Instability ◽  
St Elevation Myocardial Infarction ◽  
Treatment Modalities ◽  
Circulatory Support ◽  
Low Cardiac Output ◽  
Body Tissues ◽  
Early Revascularization ◽  
St Elevation

Cardiogenic shock (CS) due to acute ST-elevation myocardial infarction is a complex state of low cardiac output and hemodynamic instability that transmutes to hypoperfusion of various body tissues leading to multi-organ dysfunction and death. Mortality rates due to CS remain high despite many recent advances in treatment. In the management of CS, early revascularization is the mainstay of the treatment. The patient can be stabilized using fl uids, vasopressors or inotropes, mechanical circulatory support, and general intensive care techniques. Due to only few randomized trials on CS patients, there is lack of concrete evidence supporting various treatment modalities, except for revascularization. Thus, CS and its management is a topic with more controversies than conclusions regarding optimal treatment and management.

Abstract 13861: Trends in Utilization of Mechanical Circulatory Assist Devices in Patients Presenting with ST Elevation Myocardial Infarction

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Shikhar Agarwal ◽  
Venu Menon
Keyword(s):  
Myocardial Infarction ◽  
Hospital Mortality ◽  
Cardiogenic Shock ◽  
St Elevation Myocardial Infarction ◽  
Circulatory Support ◽  
Hierarchical Regression ◽  
Study Duration ◽  
Circulatory Assist Devices ◽  
St Elevation ◽  
Small Decline

Despite significant controversy about the efficacy, mechanical circulatory support (MCS) is often utilized in patients with cardiogenic shock after ST elevation myocardial infarction (STEMI). We aimed to characterize the trends and outcomes following the use of MCS devices in patients presenting with STEMI. Methods: We used the 2003-2011 US Nationwide Inpatient Sample for this study. All admissions with a principal diagnosis of STEMI were identified using standard ICD codes. MCS devices included intra aortic balloon pump or Impella and were identified using ICD procedure codes. Results: Of a total of 372984 admissions with STEMI, we identified 35685 (9.3%) cases that required MCS. Over the study duration, there was a significant increase in the utilization of MCS from 7.6% in 2003 to 10.5% in 2011 (Panel A). This increase in the use of MCS was accompanied by a significant increase in the incidence of cardiogenic shock in the study population (Panel A). Despite an increase in the overall cardiogenic shock incidence, there was a significant increase in the relative utilization of MCS in cardiogenic shock (Panel B) during the study duration. Of all the cardiogenic shock cases, utilization of MCS increased from 48.6% in 2003 to 57.4% in 2009, followed by a small decline to 54.7% in 2011. Among patients with cardiogenic shock, in-hospital mortality rate was 31.5% in patients with MCS as compared to 42.4% in those treated without MCS (p<0.001). Using multivariable hierarchical regression modeling, we found a significant reduction in adjusted in-hospital mortality with MCS, among patients with cardiogenic shock [OR (95% CI): 0.82 (0.77-0.88), p<0.001]. Conclusions: Over the last decade, there has been a significant increase in the utilization of MCS in patients with STEMI. In contrast to the results of the IABP trial, the use of MCS was associated with a significant reduction in in-hospital mortality in this real world nationwide experience.

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