Hemodynamic Effects of Intra-aortic Balloon Counterpulsation in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

Prondzinsky, Roland; Unverzagt, Susanne; Ruß, Martin; Lemm, Henning; Swyter, Michael; Wegener, Nikolas; Buerke, Ute; Raaz, Uwe; Ebelt, Henning; Schlitt, Axel; Heinroth, K. M.; Haerting, Johannes; Werdan, Karl; Buerke, Michael

doi:10.1097/shk.0b013e31824a67af

Cited by 145 publications

(84 citation statements)

References 30 publications

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“…Registry studies have reported only minimal improvement in MAP, CI, serum lactate, and catecholamine requirements with IABP counterpulsation. 1,253 Before 2012, American and European guidelines supported IABP use for CS with a Class I recommendation. The IABP-SHOCK II, which enrolled patients with MI-associated CS, found no differences in the primary end point of 30-day mortality, prespecified secondary …”

Section: Intra-aortic Balloon Pumpmentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,343

1,165

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Cardiogenic shock is a high-acuity, potentially complex, and hemodynamically diverse state of end-organ hypoperfusion that is frequently associated with multisystem organ failure. Despite improving survival in recent years, patient morbidity and mortality remain high, and there are few evidence-based therapeutic interventions known to clearly improve patient outcomes. This scientific statement on cardiogenic shock summarizes the epidemiology, pathophysiology, causes, and outcomes of cardiogenic shock; reviews contemporary best medical, surgical, mechanical circulatory support, and palliative care practices; advocates for the development of regionalized systems of care; and outlines future research priorities. Cardiogenic shock (CS) is a low-cardiac-output state resulting in life-threatening end-organ hypoperfusion and hypoxia.1,2 Acute myocardial infarction (MI) with left ventricular (LV) dysfunction remains the most frequent cause of CS. 1,3 Advances in reperfusion therapy have been associated with improvements in survival, but significant regional disparities in evidence-based care have been reported, and in-hospital mortality remains high (27%-51%).1,4-9 Management recommendations are distributed between disease-specific statements and guidelines, and a dedicated and comprehensive clinical resource in this area is lacking. Thus, consolidating the evidence to define contemporary best medical and surgical CS practices for both MI-associated CS and other types of CS may be an important step in knowledge translation to help attenuate disparities in evidence-based care.Regional systems of care coupled with treatment algorithms have improved survival in high-acuity time-sensitive conditions such as MI, out-of-hospital cardiac arrest (OHCA), and trauma.10-12 Applying a similar framework to CS management may lead to similar improvements in survival, and CS systems of care are emerging within existing regional cardiovascular emergency care networks; however, guidance from a national expert group on structure and systems of care has not been available. 13,14 Accordingly, the purposes of this American Heart Association (AHA) scientific statement on CS are to summarize our contemporary understanding of the epidemiology, pathophysiology, and in-hospital best care practices into a single clinical resource document; to suggest a stepwise management algorithm that integrates medical, surgical, and mechanical circulatory support (MCS) therapies; and to propose a Mission: Lifelinesupported pathway for the development of integrated regionalized CS systems of care. DEFINITION OF CSAcute cardiac hemodynamic instability may result from disorders that impair function of the myocardium, valves, conduction system, or pericardium, either in isolation HISTORICAL PERSPECTIVESBefore the routine use of early revascularization, MIassociated CS had an in-hospital mortality exceeding 80%. A registry trial of 250 patients with acute MI described the association between bedside physical examination (Killip classification) for the as...

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Section: Intra-aortic Balloon Pumpmentioning

confidence: 99%

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Diepen¹,

Katz²,

Albert³

et al. 2017

Circulation

1,343

1,165

View full text Add to dashboard Cite

show abstract

“…No difference was seen in APACHE II scores according to IABP use. A modest but significant improvement in haemodynamic parameters was seen in both groups, although with no benefit from IABP support over standard care [10].…”

Section: Cardiogenic Shockmentioning

confidence: 72%

“…In addition to the reduced left ventricular (LV) wall stress and myocardial demand that result from reduced afterload, studies have shown modest increases in both stroke volume and cardiac output with IABP support [6][7][8][9][10]. Although not supported by evidence, it is intuitive that this would, in turn, lead to improvements in end organ perfusion.…”

Section: Introductionmentioning

confidence: 92%

Intra-Aortic Balloon Counterpulsation in Contemporary Practice – Where Are We?

White

Ruygrok

2015

Heart, Lung and Circulation

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“…This small single center study demonstrated no significant difference in APACHE II Score between IABP use and no IABP use (Table 3). 36 The IABP-SHOCK II trial was the first large-scale multicenter randomized trial of balloon pump-supported early revascularization in AMI complicated by CS. This randomized 600 patients to IABP or no IABP in addition to optimal revascularization and intensive care.…”

Section: Post-mi and Cardiogenic Shockmentioning

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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Hemodynamic Effects of Intra-aortic Balloon Counterpulsation in Patients With Acute Myocardial Infarction Complicated by Cardiogenic Shock

Cited by 145 publications

References 30 publications

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Contemporary Management of Cardiogenic Shock: A Scientific Statement From the American Heart Association

Intra-Aortic Balloon Counterpulsation in Contemporary Practice – Where Are We?

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

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