Intra-aortic balloon counterpulsation: variations in use and complications

Azeem, Tariq; Stephens-Lloyd, Amanda; Spyt, Tom; Hartshorne, R.; Gershlick, Anthony

doi:10.1016/j.ijcard.2003.04.007

Cited by 19 publications

(6 citation statements)

References 12 publications

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“…This rate is influenced by the indication, the technique, the size of balloons, the duration of balloon treatment, the age of the patients, comorbidity, concomitant antiplatelet therapy, and methodological definition of the specific complications. 5,16,22 In our group of patients, the size of the balloon and the duration of IABP treatment are similar to that reported in the literature (Table 2). Similar to previous reports, 5,9,13 we found that older age was a predictor of bleeding complications.…”

Section: Discussionsupporting

confidence: 86%

Safety of Intra‐aortic Balloon Pump Using Glycoprotein IIb/IIIa Antagonists

Laish-Farkash

Hod

Matetzky

et al. 2009

Clinical Cardiology

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Background: Anticoagulation with heparin is recommended with intra-aortic balloon pump (IABP) to prevent thrombosis and embolization. However, anticoagulation increases the risk of bleeding, particularly in combination with glycoprotein (GP) IIb/IIIa antagonists. Hypothesis: We investigated the safety of using GP IIb/IIIa antagonists without heparin after IABP insertion in patients who underwent primary percutaneous coronary intervention (PCI). Methods: Consecutive patients with acute myocardial infarction (AMI), who underwent primary PCI and were treated with GP IIb/IIIa antagonists without concomitant heparin, and in whom IABP was inserted, were followed during hospitalization for thrombotic and hemorrhagic complications. Results: Ninety-seven patients were included in this analysis. Glycoprotein IIb/IIIa antagonist treatment duration was 12-24 h in 89% of patients, and IABP duration was up to 48 h in 97% of patients. Three patients (3.1%) developed vascular complications: 1 had a major limb ischemia (long IABP treatment), 1 had a minor limb ischemia, and 1 had a cerebrovascular event (after prolonged resuscitation). All patients were already on heparin at the time of the thrombotic events. The rates of major and minor bleeding complications were 9% and 15.5%, respectively. Conclusions: The rate of thrombotic complications is relatively low in post-primary PCI patients with IABP treated with GP IIb/IIIa antagonists without concomitant heparin therapy. Such an approach may reduce the risk of hemorrhagic complications, with low risk of thrombotic complications.Key words: intra-aortic balloon pump, myocardial infarction, glycoprotein IIb/IIIa antagonists, complications IntroductionAlthough anticoagulation with heparin is recommended during intra-aortic balloon pump (IABP) to prevent catheterrelated thrombosis and embolization, 1 no data or guidelines exist to support this strategy. 2 In fact, 1 study that randomly assigned 153 patients to receive heparin (or no heparin) during IABP found no difference in the incidence of limb ischemia. 3 Moreover, with advanced technology, the IABP catheter has a lower profile and the incidence of limb ischemia has decreased. 4 The incidence of major limb ischemia in IABP patients treated with heparin alone is 0.9%, 5,6 reaching 10.3% in post-operative patients, 7 while the incidence of minor limb ischemia in IABP patients treated with heparin alone is as high as 4.2%.

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Section: Discussionsupporting

confidence: 86%

Safety of Intra‐aortic Balloon Pump Using Glycoprotein IIb/IIIa Antagonists

Laish-Farkash

Hod

Matetzky

et al. 2009

Clinical Cardiology

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“…However, a study by Cristal et al reported true bacteraemia and sepsis in IABP patients in 15% and 12%, respectively, mainly during the first 48 h after insertion [24]. As shown in previous studies, complication rate decreased with the introduction of smaller French size catheters [22, 25, 26]. …”

Section: Discussionmentioning

confidence: 96%

Encouraging survival rates in patients with acute myocardial infarction treated with an intra-aortic balloon pump

et al. 2011

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ObjectiveTo evaluate a 30-day and long-term outcome of patients with acute myocardial infarction (AMI) treated with intra-aortic balloon pump (IABP) counterpulsation and to identify predictors of a 30-day and long-term all-cause mortality.MethodsRetrospective cohort study of 437 consecutive AMI patients treated with IABP between January 1990 and June 2004. A Cox proportional hazards model was used to identify predictors of a 30-day and long-term all-cause mortality.ResultsMean age of the study population was 61 ± 11 years, 80% of the patients were male, and 68% had cardiogenic shock. Survival until IABP removal after successful haemodynamic stabilisation was 78% (n = 341). Cumulative 30-day survival was 68%. Median follow-up was 2.9 years (range, 6 months to 15 years). In patients who survived until IABP removal, cumulative 1-, 5-, and 10-year survival was 75%, 61%, and 39%, respectively. Independent predictors of higher long-term mortality were prior cerebrovascular accident (hazard ratio (HR), 1.8; 95% confidence interval (CI), 1.0–3.4), need for antiarrhythmic drugs (HR, 2.3; 95% CI, 1.5–3.3), and need for renal replacement therapy (HR, 2.3; 95% CI, 1.2–4.3). Independent predictors of lower long-term mortality were primary percutaneous coronary intervention (PCI; HR, 0.6; 95% CI, 0.4–1.0), failed thrombolysis with rescue PCI (HR, 0.5; 95% CI, 0.3–0.9), and coronary artery bypass grafting (HR, 0.3; 95% CI, 0.1–0.5).ConclusionsDespite high in-hospital mortality in patients with AMI treated with IABP, a favourable number of patients survived in the long-term. These results underscore the value of aggressive haemodynamic support of patients throughout the acute phase of AMI.

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“…Anterior wall MI therefore carries a high risk of the development of CS. It is a serious complication, developing in approximately 6–8% of AMIs and has a 30‐day mortality rate to near 50% (Sanborn and Feldman, 2004) although overall mortality rates are as high as 50–80% (Hochman et al , 1995; Barron et al , 2001; Azeem et al , 2004). It is the leading cause of death in patients with AMI (Menon and Hochman, 2002).…”

Section: Introductionmentioning

confidence: 99%

“…A polyurethane balloon sits in the descending thoracic aorta, 2 cm distal to the branch of the left subclavian artery, and is most commonly inserted via the femoral artery (Azeem et al , 2004). In a process called counterpulsation, the balloon inflates during diastole augmenting diastolic blood pressure.…”

Section: Introductionmentioning

confidence: 99%

“…An analysis of 911 patients requiring IABC during coronary artery bypass grafting found that the use of a sheath during insertion of an IABP catheter was an independent risk factor for the development of complications (Meharwal and Trehan, 2002). This implies that patients may benefit from sheathless catheter insertion due to the smaller diameter, decreasing the likelihood of an arterial obstruction occurring (Cohen et al , 2000; Meco et al , 2002; Azeem et al , 2004). A large registry of aortic counterpulsation found evidence to suggest that the rate of major limb ischaemia was lower than in previous reports, possibly due to smaller catheters being used and patients being administered heparin and glycoprotein inhibitors (Ferguson et al , 2001).…”

Section: Introductionmentioning

confidence: 99%

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Intra‐aortic balloon counterpulsation complicated by limb ischaemia: a reflective commentary

Sice

2006

Nursing in Critical Care

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Intra-aortic balloon counterpulsation (IABC) is widely used to support the failing myocardium, particularly in patients with a background of acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). CS is primarily due to left ventricular failure and is the most serious complication of AMI. Using Driscoll's 'What?' reflective model to guide critical thinking, an incident involving a patient who required IABC following AMI is explored. There are various complications associated with IABC, limb ischaemia being very common. Risk factors, which predispose patients to the development of limb ischaemia following intra-aortic balloon pump insertion, are discussed as are the issues surrounding their care. Nurses are in an ideal position to detect any complications that may occur. They should be familiar with the patient's medical history, including any risk factors, which could predispose them to the development of limb ischaemia. Consideration of these factors and the adjunctive treatment the patient may require can be used to plan care accordingly. Anecdotal evidence suggests that more patients are requiring haemodynamic support from IABC. Nurses and health care professionals who have the responsibility of caring for these patients need to be adequately trained in order to maintain a high standard of care. However, there appears to be a lack of evidence-based guidelines determining the optimum frequency of limb observations to assess for limb ischaemia. Further evidence as to the timing of limb observations is required in order that protocols can be written to guide the practice.

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Intra-aortic balloon counterpulsation: variations in use and complications

Cited by 19 publications

References 12 publications

Safety of Intra‐aortic Balloon Pump Using Glycoprotein IIb/IIIa Antagonists

Safety of Intra‐aortic Balloon Pump Using Glycoprotein IIb/IIIa Antagonists

Encouraging survival rates in patients with acute myocardial infarction treated with an intra-aortic balloon pump

Intra‐aortic balloon counterpulsation complicated by limb ischaemia: a reflective commentary

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