Intraaortic balloon pump counterpulsation
- Roger J Laham, MD
Roger J Laham, MD
- Associate Professor of Medicine
- Harvard Medical School
- Julian M Aroesty, MD
Julian M Aroesty, MD
- Clinical Associate Professor of Medicine
- Harvard Medical School
- Section Editors
- Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
Bernard J Gersh, MB, ChB, DPhil, FRCP, MACC
- Editor-in-Chief — Cardiovascular Medicine
- Section Editor — Coronary Heart Disease; Myopericardial Disease
- Professor of Medicine
- Mayo Clinic College of Medicine
- Donald Cutlip, MD
Donald Cutlip, MD
- Section Editor — Interventional Cardiology
- Professor of Medicine
- Harvard Medical School
- Beth Israel Deaconess Medical Center
Intraaortic balloon pump counterpulsation (IABP) is one type of mechanical hemodynamic support, and it has emerged as the single most widely used circulatory assist device. It is used in a variety of clinical conditions [1,2]:
●Cardiogenic shock (left ventricular failure or mechanical complications of an acute myocardial infarction)
●Low cardiac output after cardiopulmonary bypass
●Adjunctive therapy in high risk or complicated angioplasty [3,4]
- Santa-Cruz RA, Cohen MG, Ohman EM. Aortic counterpulsation: a review of the hemodynamic effects and indications for use. Catheter Cardiovasc Interv 2006; 67:68.
- Ferguson JJ 3rd, Cohen M, Freedman RJ Jr, et al. The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry. J Am Coll Cardiol 2001; 38:1456.
- Ishihara M, Sato H, Tateishi H, et al. Intraaortic balloon pumping as the postangioplasty strategy in acute myocardial infarction. Am Heart J 1991; 122:385.
- Lincoff AM, Popma JJ, Ellis SG, et al. Percutaneous support devices for high risk or complicated coronary angioplasty. J Am Coll Cardiol 1991; 17:770.
- Rajai HR, Hartman CW, Innes BJ, et al. Prophylactic use of intra-aortic ballon pump in aortocoronary bypass for patients with left main coronary artery disease. Ann Surg 1978; 187:118.
- Raman J, Loor G, London M, Jolly N. Subclavian artery access for ambulatory balloon pump insertion. Ann Thorac Surg 2010; 90:1032.
- Weber KT, Janicki JS. Intraaortic balloon counterpulsation. A review of physiological principles, clinical results, and device safety. Ann Thorac Surg 1974; 17:602.
- Marchionni N, Fumagalli S, Baldereschi G, et al. Effective arterial elastance and the hemodynamic effects of intraaortic balloon counterpulsation in patients with coronary heart disease. Am Heart J 1998; 135:855.
- Scheidt S, Wilner G, Mueller H, et al. Intra-aortic balloon counterpulsation in cardiogenic shock. Report of a co-operative clinical trial. N Engl J Med 1973; 288:979.
- Urschel CW, Eber L, Forrester J, et al. Alteration of mechanical performance of the ventricle by intraaortic balloon counterpulsation. Am J Cardiol 1970; 25:546.
- Port SC, Patel S, Schmidt DH. Effects of intraaortic balloon counterpulsation on myocardial blood flow in patients with severe coronary artery disease. J Am Coll Cardiol 1984; 3:1367.
- Williams DO, Korr KS, Gewirtz H, Most AS. The effect of intraaortic balloon counterpulsation on regional myocardial blood flow and oxygen consumption in the presence of coronary artery stenosis in patients with unstable angina. Circulation 1982; 66:593.
- Mueller H, Ayres SM, Conklin EF, et al. The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction. J Clin Invest 1971; 50:1885.
- Kern MJ, Aguirre FV, Tatineni S, et al. Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically ill patients. J Am Coll Cardiol 1993; 21:359.
- Kern MJ, Aguirre F, Bach R, et al. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation 1993; 87:500.
- Ishihara M, Sato H, Tateishi H, et al. Effects of intraaortic balloon pumping on coronary hemodynamics after coronary angioplasty in patients with acute myocardial infarction. Am Heart J 1992; 124:1133.
- Antman EM, Anbe DT, Armstrong PW, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction. www.acc.org/qualityandscience/clinical/statements.htm (Accessed on August 24, 2006).
- Weintraub RM, Voukydis PC, Aroesty JM, et al. Treatment of preinfarction angina with intraaortic balloon counterpulsation and surgery. Am J Cardiol 1974; 34:809.
- Flaherty JT, Becker LC, Weiss JL, et al. Results of a randomized prospective trial of intraaortic balloon counterpulsation and intravenous nitroglycerin in patients with acute myocardial infarction. J Am Coll Cardiol 1985; 6:434.
- Mishra S, Chu WW, Torguson R, et al. Role of prophylactic intra-aortic balloon pump in high-risk patients undergoing percutaneous coronary intervention. Am J Cardiol 2006; 98:608.
- Brodie BR, Stuckey TD, Hansen C, Muncy D. Intra-aortic balloon counterpulsation before primary percutaneous transluminal coronary angioplasty reduces catheterization laboratory events in high-risk patients with acute myocardial infarction. Am J Cardiol 1999; 84:18.
- Perera D, Stables R, Thomas M, et al. Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention: a randomized controlled trial. JAMA 2010; 304:867.
- Perera D, Stables R, Clayton T, et al. Long-term mortality data from the balloon pump-assisted coronary intervention study (BCIS-1): a randomized, controlled trial of elective balloon counterpulsation during high-risk percutaneous coronary intervention. Circulation 2013; 127:207.
- Fotopoulos GD, Mason MJ, Walker S, et al. Stabilisation of medically refractory ventricular arrhythmia by intra-aortic balloon counterpulsation. Heart 1999; 82:96.
- Gold HK, Leinbach RC, Sanders CA, et al. Intraaortic balloon pumping for ventricular septal defect or mitral regurgitation complicating acute myocardial infarction. Circulation 1973; 47:1191.
- Eltchaninoff H, Dimas AP, Whitlow PL. Complications associated with percutaneous placement and use of intraaortic balloon counterpulsation. Am J Cardiol 1993; 71:328.
- Theologou T, Bashir M, Rengarajan A, et al. Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting. Cochrane Database Syst Rev 2011; :CD004472.
- Eagle KA, Guyton RA, Davidoff R, et al. ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery). Circulation 2004; 110:e340.
- Kushner FG, Hand M, Smith SC Jr, et al. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2009; 54:2205.
- Barnett MG, Swartz MT, Peterson GJ, et al. Vascular complications from intraaortic balloons: risk analysis. J Vasc Surg 1994; 19:81.
- Funk M, Ford CF, Foell DW, et al. Frequency of long-term lower limb ischemia associated with intraaortic balloon pump use. Am J Cardiol 1992; 70:1195.
- Patel JJ, Kopisyansky C, Boston B, et al. Prospective evaluation of complications associated with percutaneous intraaortic balloon counterpulsation. Am J Cardiol 1995; 76:1205.
- Rastan AJ, Tillmann E, Subramanian S, et al. Visceral arterial compromise during intra-aortic balloon counterpulsation therapy. Circulation 2010; 122:S92.
- Anderson RD, Ohman EM, Holmes DR Jr, et al. Use of intraaortic balloon counterpulsation in patients presenting with cardiogenic shock: observations from the GUSTO-I Study. Global Utilization of Streptokinase and TPA for Occluded Coronary Arteries. J Am Coll Cardiol 1997; 30:708.
- Alderman JD, Gabliani GI, McCabe CH, et al. Incidence and management of limb ischemia with percutaneous wire-guided intraaortic balloon catheters. J Am Coll Cardiol 1987; 9:524.
- Hyman BT, Landas SK, Ashman RF, et al. Warfarin-related purple toes syndrome and cholesterol microembolization. Am J Med 1987; 82:1233.
- Aksnes J, Abdelnoor M, Berge V, Fjeld NB. Risk factors of septicemia and perioperative myocardial infarction in a cohort of patients supported with intra-aortic balloon pump (IABP) in the course of open heart surgery. Eur J Cardiothorac Surg 1993; 7:153.
- Aru GM, King JT Jr, Hovaguimian H, et al. The entrapped balloon: report of a possibly serious complication. J Thorac Cardiovasc Surg 1986; 91:146.
- Tatar H, Ciçek S, Demirkilic U, et al. Vascular complications of intraaortic balloon pumping: unsheathed versus sheathed insertion. Ann Thorac Surg 1993; 55:1518.
- Gottlieb SO, Brinker JA, Borkon AM, et al. Identification of patients at high risk for complications of intraaortic balloon counterpulsation: a multivariate risk factor analysis. Am J Cardiol 1984; 53:1135.
- Scholz KH, Ragab S, von zur Mühlen F, et al. Complications of intra-aortic balloon counterpulsation. The role of catheter size and duration of support in a multivariate analysis of risk. Eur Heart J 1998; 19:458.
- Cohen M, Dawson MS, Kopistansky C, McBride R. Sex and other predictors of intra-aortic balloon counterpulsation-related complications: prospective study of 1119 consecutive patients. Am Heart J 2000; 139:282.
- Chen EW, Canto JG, Parsons LS, et al. Relation between hospital intra-aortic balloon counterpulsation volume and mortality in acute myocardial infarction complicated by cardiogenic shock. Circulation 2003; 108:951.
- Erdogan HB, Goksedef D, Erentug V, et al. In which patients should sheathless IABP be used? An analysis of vascular complications in 1211 cases. J Card Surg 2006; 21:342.
- Meharwal ZS, Trehan N. Vascular complications of intra-aortic balloon insertion in patients undergoing coronary reavscularization: analysis of 911 cases. Eur J Cardiothorac Surg 2002; 21:741.
- TECHNICAL ASPECTS
- HEMODYNAMIC EFFECTS
- Effects on coronary artery blood flow
- Refractory myocardial ischemia
- Cardiogenic shock
- High-risk PCI
- Primary PCI for acute MI
- Refractory ventricular arrhythmias
- Refractory heart failure
- Other potential uses
- Recommendations of others
- DURATION OF USE
- Factors increasing IABP complications
- Factors decreasing IABP complications
- Routine care
- SUMMARY AND RECOMMENDATIONS