The Impact of Intra‐Aortic Balloon Pump Weaning Protocols on In‐Hospital Clinical Outcomes

Abstract

This study suggests that weaning protocols offer no hemodynamic benefits or improvement in in-hospital mortality rates. Weaning is associated with trend toward increased length of stay. We conclude that weaning offers no advantage over direct device removal and would advocate that balloon pumps be directly withdrawn when counterpulsation is terminated.

Current and future applications of the intra-aortic balloon pump

“…The insignificant hemodynamic effect of reduced assist ratios has been reported in both experimental and small clinical studies [53][54][55]. Moreover, in a recent, singlecenter, retrospective study, patients who were weaned from the IABP with the use of a protocol were compared with patients who were abruptly disconnected from the IABP [56]. The use of a protocol was associated with a higher heart rate after weaning, though no differences were observed in systolic and mean blood pressures, urinary output and mortality.…”

The Optimal Weaning Strategy for Intraaortic Balloon Counterpulsation: Volume-Based Versus Rate-Based Approach in an Animal Model

“…Nonetheless, IABP is still widely used worldwide and it is still a Class IIA recommendation in the 2013 American College of Cardiology/American Heart Association guidelines [9]. Previous studies have advocated gradual weaning of an IABP before removal [10][11][12], although a recent report demonstrated no advantage of gradual weaning over direct device removal [13]. However, even though IABP currently represents the first-line left assist device in patients with a compromised left ventricle, little or no research evidence is available to answer the question of which of the two available methods is the best method to wean a patient from the IABP: frequency-reduction or volume-reduction.…”

17. Mechanical Circulatory Support Devices

“…The IABP can also be weaned by maintaining a ventricular rate of 1:1 and deflating the balloon over several hours. This leads to a decrease in the counterpulsation and a decrease in diastolic augmentation [25,26]. There are limited studies in the literature that have assessed which weaning method is superior.…”