First-Line Support by Intra-Aortic Balloon Pump in Non-Ischaemic Cardiogenic Shock in the Era of Modern Ventricular Assist Devices

Abstract

Objectives: Little is known about circulatory support in cardiogenic shock (CS) from other causes than the acute coronary syndrome or after cardiotomy. We evaluated the effects of first-line intra-aortic balloon pump (IABP) support in this subpopulation of CS patients.

Methods: A retrospective study was performed in 27 patients with CS from end-stage cardiomyopathy supported firstly by IABP in the years 2011-2016.

Results: At 24 h, lactate decreased from 3.2 (2.1-6.8) to 1.8 (1.2-2.2) mmol/L (p < 0.001). Eighteen patients (67%) defined as IABP responders were successfully bridged to either recovery (n = 7), left ventricular assist device (n = 5), or heart transplantation (n = 6). IABP failed in 9 patients (non-responders, 33%) who either died (n = 7) or needed support by extracorporeal membrane oxygenation (n = 2). At 24 h of IABP support, urinary output was higher (2,660 [1,835-4,440] vs. 1,200 [649-2,385] mL; p = 0.02) and fluid balance more negative (-1,564 [-2,673 to -1,086] vs. -500 [-930 to +240] mL; p < 0.001) in responders than non-responders. Overall survival at 1 year was 63%.

Conclusion: In most patients, first-line support by IABP in end-stage cardiomyopathy is associated with improvement in organ perfusion and clinical stabilisation for at least 24 h allowing time for decision making on next therapies.

Keywords: Cardiogenic shock; Cardiomyopathy; End-stage heart failure; Intra-aortic balloon pump; Mechanical circulatory support.

Fig. 1

Distribution of indications for intra-aortic balloon pump in our Centre. AMI, acute myocardial infarction; PCI, percutaneous coronary intervention.

Fig. 2

Flow chart of outcomes. ECMO, extracorporeal membrane oxygenation; HTx, heart transplantation; IABP, intra-aortic balloon pump; LVAD, left ventricular assist device.

Fig. 3

Box-and-whiskers plots of changes in mean arterial pressure (a), central venous pressure (b), 24-h urinary production (c), and 24-h fluid balance (d). Boxes indicate interquartile ranges and whiskers minimum and maximum values. □, IABP responders; ■, IABP non-responders. * p < 0.05, ** p < 0.01.

Fig. 4

Kaplan-Meier survival curve of the study population versus patients on intra-aortic balloon pump for shock from acute myocardial infarction (AMI) and predicted survival according to the HeartMate II risk score.