Lack of Survival Benefit Found With Use of Intraaortic Balloon Pump in Extracorporeal Membrane Oxygenation: A Pooled Experience of 1517 Patients

Abstract

Objective: Intraaortic balloon pumps (IABPs) are frequently used as an adjunctive device to extracorporeal membrane oxygenation (ECMO) and are routinely placed at the initiation of ECMO at many institutions. Evidence for the additive benefit of IABP therapy is limited and conflicting in part due to small sample sizes. In the absence of large randomized trials, a meta-analysis would best elucidate potential benefit.

Methods: A systematic PubMed/Medline search was performed. Studies reporting on survival to hospital discharge for cardiogenic shock and cardiac arrest requiring ECMO with an IABP subgroup were included. Concomitant IABP was compared with patients on ECMO alone. Secondary analyses included acute myocardial infarction (AMI) and postcardiotomy cardiogenic shock (PCS) subgroups, as well as timing of IABP insertion.

Results: Sixteen studies were included in the main analysis, encompassing 1517 patients. The cumulative survival rate for patients on ECMO was 256/683 (37.5%) compared with 294/834 (35.3%) for patients with adjunctive IABP. Concomitant IABP was not associated with improved survival (risk ratio [RR], 1.143; 95% confidence interval [CI], 0.973-1.343; P=.10). IABP was not associated with improved survival in AMI patients (RR, 1.120; 95% CI, 0.772-1.624; P=.55), PCS (RR, 1.121; 95% CI, 0.826-1.520; P=.46) when placed prior to ECMO initiation (RR, 0.948; 95% CI, 0.718-1.252; P=.71), or when routinely inserted (RR, 1.102; 95% CI, 0.806-1.506; P=.54).

Conclusion: Based on this observational analysis, the concomitant use of IABP with ECMO did not appear associated with a dramatic change in survival outcomes. The routine insertion of concomitant IABP with ECMO is not supported by our findings.