First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices.

Abstract

OBJECTIVES:

Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients.

METHODS:

A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016.

RESULTS:

At 24 h, lactate decreased from 3.2 (2.1-6.8) to 1.8 (1.2-2.2) mmol/L (p < 0.001). Eighteen patients (67%) defined as IABP responders were successfully bridged to either recovery (n = 7), left ventricular assist device (n = 5), or heart transplantation (n = 6). IABP failed in 9 patients (non-responders, 33%) who either died (n = 7) or needed support by extracorporeal membrane oxygenation (n = 2). At 24 h of IABP support, urinary output was higher (2,660 [1,835-4,440] vs. 1,200 [649-2,385] mL; p = 0.02) and fluid balance more negative (-1,564 [-2,673 to -1,086] vs. -500 [-930 to +240] mL; p < 0.001) in responders than non-responders. Overall survival at 1 year was 63%.

CONCLUSION:

In most patients, first-line support by IABP in end-stage cardiomyopathy is associated with improvement in organ perfusion and clinical stabilisation for at least 24 h allowing time for decision making on next therapies.

• Authors: Corstiaan A den Uil, Giorgia Galli, Lucia S Jewbali, Kadir Caliskan, Olivier C Manintveld, Jasper J Brugts, Nicolas M van Mieghem, Mattie J Lenzen, Eric Boersma, Alina A Constantinescu
• Journal: Cardiology (Cardiology) 2017 Vol. 138 Issue 1 Pg. 1-8 ISSN: 1421-9751 [Electronic] Switzerland
• PMID: 28501864 (Publication Type: Journal Article)
• Copyright: © 2017 The Author(s) Published by S. Karger AG, Basel.

Topics

• Adult
• Cardiomyopathies (complications)
• Decision Making
• Equipment Failure
• Extracorporeal Membrane Oxygenation
• Female
• Heart Failure (complications)
• Heart Transplantation (methods)
• Heart-Assist Devices (adverse effects)
• Humans
• Intra-Aortic Balloon Pumping (adverse effects, methods)
• Male
• Middle Aged
• Netherlands
• Retrospective Studies
• Shock, Cardiogenic (mortality, surgery)
• Survival Analysis
• Treatment Outcome