Intraaortic Balloon Counterpulsation: A Review

Abstract

The intraaortic balloon counterpulsation pump (IABP) was successfully placed in 54 patients from 1972 to January 1978. Total overall survival was 46% (25/54). In the past 3 years survival was doubled (54% — 21/39) compared to the initial experience from 1972 through 1975 (27% — 4/15). Eleven percent (6/54) of the patients died after the IABP was removed, 19% (10/54) became balloon-dependent, and 24% (13/54) had either a poor response or no response to IABP.Indications for IABP were cardiogenic shock secondary to myocardial infarction (CS-MI), preinfarction angina, postoperative cardiopulmonary bypass dependency (CPBD), the most common indication, or post cardiotomy cardiogenic shock. Preoperative prophylactic placement of the balloon was used in 7 patients with a 57% (4/7) survival. None of the 10 patients treated for CS-MI survived to discharge. Fifty-one percent (18/35) of CPBD patients were long-term survivors.Complications including difficulty passing the device (15/54), thrombosis (6/54), minor dissection (3/54), or combinations of these problems occurred in 41% (22/54) of the patients. Hemodynamic and metabolic parameters were also reviewed. Early recognition of cardiogenic shock and prompt placement of the IABP are essential to insure decreased morbidity and increased survival in these critically ill patients.