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. 2024 Nov 29;28(1):394.
doi: 10.1186/s13054-024-05129-1.

Intra-aortic balloon pump after VA-ECMO reduces mortality in patients with cardiogenic shock: an analysis of the Chinese extracorporeal life support registry

Kexin Wang #  1 , Liangshan Wang #  1 , Jiawang Ma  1 , Haixiu Xie  1 , Chenglong Li  1 , Xing Hao  1 , Zhongtao Du  2 , Hong Wang  3 , Xiaotong Hou  4
Affiliations

Intra-aortic balloon pump after VA-ECMO reduces mortality in patients with cardiogenic shock: an analysis of the Chinese extracorporeal life support registry

Kexin Wang et al. Crit Care. .

Abstract

Background: The role of intra-aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA-ECMO) in patients with cardiogenic shock (CS) remains unclear. This study investigated the effect of applying IABP for left ventricle (LV) unloading after VA-ECMO on reducing mortality in patients with CS.

Methods: Data from 5,492 consecutive patients with CS treated with VA-ECMO between January 2017 and July 2023 were collected from the CSECLS registry. The primary outcome was in-hospital mortality. The secondary outcomes included 30-day mortality, survival on VA-ECMO, and various complications. The association between the application of IABP after VA-ECMO and in-hospital outcomes was assessed.

Results: Among 5,492 patients undergoing VA-ECMO (mean age 54.7 ± 15.1 years, 3,917 [71.3%] male), 832 (15.1%) received IABP after VA-ECMO. Before VA-ECMO, a higher incidence of cardiac intervention (13.9% vs. 16.7%) and myocardial infarction (12.0% vs. 14.8%) (all P < 0.05) was seen in the IABP after VA-ECMO group. In this cohort, the IABP after VA-ECMO group had a lower in-hospital mortality (52.5% vs. 48.0%, P = 0.017) and a higher survival rate on VA-ECMO (75.4% vs. 79.4%, P = 0.014). On multivariate modeling, the use of IABP after VA-ECMO was associated with a lower risk of in-hospital mortality (adjusted odds ratio[aOR], 0.823 [95% confidence interval [CI], 0.686-0.987]; P = 0.035) and on-support mortality (aOR, 0.828 [95% CI, 0.688-0.995]; P = 0.044). However, the use of IABP after VA-ECMO was also associated with an increased incidence of complications, including mechanical (aOR: 1.905, [95% CI, 1.278-2.839]; P = 0.002), bleeding (aOR: 1.371, [95% CI, 1.092-1.721]; P = 0.007), renal (aOR: 1.252, [95% CI, 1.041-1.505]; P = 0.017), and pulmonary (aOR: 1.768, [95% CI, 1.446-2.163]; P < 0.001).

Conclusion: In this multicenter retrospective study, the use of IABP after VA-ECMO was associated with lower in-hospital mortality in patients with CS. These findings suggest that IABP may offer advantages for LV unloading in patients with CS treated with VA-ECMO, but further validation through randomized controlled trials is warranted to better understand the balance of risks and benefits.

Keywords: Cardiogenic shock; Intra-aortic balloon pump; Venoarterial extracorporeal membrane oxygenation.

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Conflict of interest statement

Declarations. Ethics approval and consent to participate: The study was approved by the institutional ethics committee/review board of the Beijing Anzhen Hospital. Informed consent for demographic, physiological and hospital-outcome data analyses was not obtained because this observational study did not modify existing diagnostic or therapeutic strategies. Consent for publication: Not applicable. Competing interests: The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Study flowchart
Fig. 2
Fig. 2
The relationship between the use of IABP and outcomes Adjusted for age, gender, BMI, comorbid conditions, pre-ECMO cardiac arrest, and vasopressors.
Fig. 3
Fig. 3
The curve of survival between the two group
Fig. 4
Fig. 4
Subgroup analyses examining the association between IABP use after ECMO and mortality
See this image and copyright information in PMC

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