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. 2023 Nov 1;69(11):977-983.
doi: 10.1097/MAT.0000000000002014. Epub 2023 Jul 26.

Predicting Hemodynamic Changes During Intra-Aortic Balloon Pump Support With a Longitudinal Evaluation

Francesco Castagna  1 , Shankar Viswanathan  2 , George Chalhoub  1 , Paul Ippolito  1 , Julio Andres Ovalle Ramos  1 , Sasa Vukelic  1 , Daniel B Sims  1 , Shivank Madan  1 , Omar Saeed  1 , Ulrich P Jorde  1
Affiliations

Predicting Hemodynamic Changes During Intra-Aortic Balloon Pump Support With a Longitudinal Evaluation

Francesco Castagna et al. ASAIO J. .

Abstract

The use of intra-aortic balloon pump (IABP) has decreased in recent years due to negative outcome studies in cardiogenic shock complicating acute myocardial infarction, despite its favorable adverse-event profile. Acute hemodynamic response studies have identified potential super-responders with immediate improvements in cardiac index (CI) in heart failure patients. This single-center retrospective study aimed to predict CI and mean arterial pressure (MAP) changes throughout the entire duration of IABP support. The study analyzed 336 patients who received IABP between 2016 and 2022. Linear mixed-effect regression models were used to predict CI and MAP improvement during IABP support. The results showed that CI and MAP increases during the first days of support, and changes during IABP support varied with time and were associated with baseline parameters. Longitudinal CI change was associated with body surface area, baseline CI, baseline pulmonary artery pulsatility index, baseline need for pressors, and diabetes. Longitudinal MAP change was associated with baseline MAP, baseline heart rate, need for pressors, or inotropes. The study recommends considering these parameters when deciding if IABP is the most appropriate form of support for a specific patient. Further prospective studies are needed to validate the findings.

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Conflict of interest statement

Disclosure: F.C. is supported by a grant from the National Institute for Health (T32HL144456) and by the National Center for Advancing Translational Science (NCATS) Clinical and Translational Science Award at Einstein-Montefiore (UL1TR001073). U.P.J. is supported by the McAdam Family Foundation. The other authors have no conflicts of interest to report.

Figures

None
Graphical abstract
Figure 1.
Figure 1.
Acute changes in cardiac index and mean arterial pressure following IABP insertion. A: Acute change in cardiac index (L/min/m2) after IABP insertion. Each vertical line represents a single patient. The red dotted line represents the top quartile (super-responders). B: Acute change in mean arterial pressure (mmHg) after IABP insertion. Each vertical line represents a single patient. The red dotted line represents the top quartile (super-responders). IABP, intra-aortic balloon pump.
Figure 2.
Figure 2.
Longitudinal changes in cardiac index and mean arterial pressure during IABP support. A: Adjusted predictions with 95% confidence interval of mean longitudinal increase in cardiac index during IABP support. B: Adjusted predictions with 95% confidence interval of mean longitudinal increase in mean arterial pressure during IABP support. IABP, intra-aortic balloon pump.
See this image and copyright information in PMC

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