From the Guidelines
Intra-Aortic Balloon Pump (IABP) therapy is recommended for patients with cardiogenic shock, refractory ischemia, or severe heart failure, as it can improve hemodynamics and reduce mortality, as evidenced by the 2013 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-st-elevation myocardial infarction 1.
Indications for IABP Therapy
- Cardiogenic shock
- Refractory ischemia despite maximal medical management
- High-risk percutaneous coronary intervention
- Mechanical complications of myocardial infarction
- Bridge to definitive therapy
Mechanism of Action
The IABP works by inflating during diastole to increase coronary perfusion and deflating just before systole to decrease afterload, thereby improving cardiac output and reducing myocardial oxygen demand.
Complications and Considerations
- Limb ischemia
- Bleeding
- Infection
- Vascular injury
- Anticoagulation required, usually with unfractionated heparin targeting an aPTT of 50-70 seconds to prevent thromboembolism
Duration of Therapy
IABP therapy is typically continued until hemodynamic stability is achieved or more definitive therapy is implemented, usually ranging from hours to several days.
Physiological Benefit
The counterpulsation mechanism of the IABP augments coronary blood flow while simultaneously reducing the workload on the failing heart, providing crucial support during acute cardiac crises, as supported by the European Society of Cardiology guidelines 1.
From the Research
Intra-Aortic Balloon Pump (IABP) Overview
- The Intra-Aortic Balloon Pump (IABP) is a device used for mechanical circulatory support in patients with cardiogenic shock 2, 3.
- It works by external counterpulsation, using systolic unloading and diastolic augmentation of aortic pressure to improve hemodynamics 2.
- Although IABP provides less hemodynamic support compared to newer devices, it remains a viable option due to its simplicity, smaller size, and better safety profile 2, 3.
Clinical Applications and Efficacy
- IABP has been used for over 5 decades as a common mechanical circulatory support device for cardiogenic shock, with a favorable safety profile 3.
- Studies have shown mixed results regarding the efficacy of IABP in cardiogenic shock, with some trials showing no significant benefit in mortality rates 4, 5.
- However, a recent propensity score matching analysis found that IABP treatment was associated with lower in-hospital mortality and 1-year mortality in patients with cardiogenic shock 6.
Pathophysiological Considerations
- The role of IABP in cardiogenic shock treatment remains unclear, and its use may depend on specific pathophysiological features, such as cardiogenic shock severity and filling status 4.
- IABP may be more suitable in clinical scenarios characterized by a disproportionate increase in afterload without profound hemodynamic compromise, such as acute decompensated heart failure 4.
- Hemodynamic variables, such as left ventricular afterload and cardiac output, may predict response to IABP and guide patient selection 4.