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Review
. 2020 Oct;17(5):247-260.
doi: 10.1007/s11897-020-00480-0.

Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

Jesse R Kimman  1 , Nicolas M Van Mieghem  2 , Henrik Endeman  3 , Jasper J Brugts  2 , Alina A Constantinescu  2 , Olivier C Manintveld  2 , Eric A Dubois  2   3 , Corstiaan A den Uil  2   3
Affiliations
Review

Mechanical Support in Early Cardiogenic Shock: What Is the Role of Intra-aortic Balloon Counterpulsation?

Jesse R Kimman et al. Curr Heart Fail Rep. 2020 Oct.

Abstract

Purpose of review: We aim to summarize recent insights and provide an up-to-date overview on the role of intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS).

Recent findings: In the largest randomized controlled trial (RCT) of patients with CS after acute myocardial infarction (AMICS), IABP did not lower mortality. However, recent data suggest a role for IABP in patients who have persistent ischemia after revascularization. Moreover, in the growing population of CS not caused by acute coronary syndrome (ACS), multiple retrospective studies and one small RCT report on significant hemodynamic improvement following (early) initiation of IABP support, which allowed bridging of most patients to recovery or definitive therapies like heart transplant or a left ventricular assist device (LVAD). Routine use of IABP in patients with AMICS is not recommended, but many patients with CS either from ischemic or non-ischemic cause may benefit from IABP at least for hemodynamic improvement in the short term. There is a need for a larger RCT regarding the role of IABP in selected patients with ACS, as well as in patients with non-ACS CS.

Keywords: Cardiogenic shock; Heart failure; Intra-aortic balloon counterpulsation; Mechanical circulatory support.

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Conflict of interest statement

Dr. Van Mieghem reports grants and personal fees from PulseCath BV, grants and personal fees from Abbott Vascular, grants and personal fees from Medtronic, grants and personal fees from Biotronik, grants and personal fees from Boston Scientific, and personal fees from Abiomed, all outside the submitted work. All other authors declare no conflicts of interest related to the content of this manuscript.

Figures

Fig. 1
Fig. 1
Hemodynamic effects of an IABP in patients with reduced ejection fraction. a Immediate effect on aortic pressure curve after initiation of IABP in a patient with 14% ejection fraction. b Corresponding pressure-volume loops showing left shift with reduction in systolic pressure, and increased stroke volume. Copied with permission from Bastos et al. [8] and Schreuder et al. [9]
See this image and copyright information in PMC

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