From the Guidelines
Counterpulsation is most frequently utilized to assist patients suffering from left ventricular failure. This therapeutic approach, commonly implemented through an intra-aortic balloon pump (IABP), works by inflating during diastole and deflating during systole. The timing of this inflation-deflation sequence increases coronary perfusion while simultaneously reducing afterload on the failing left ventricle. By augmenting diastolic pressure, counterpulsation improves blood flow to the coronary arteries, enhancing myocardial oxygen supply. Simultaneously, the rapid deflation before systole creates a vacuum effect that reduces the workload on the left ventricle during ejection. This mechanism is particularly beneficial for patients with cardiogenic shock, acute myocardial infarction with pump failure, or as a bridge to more definitive therapies like cardiac surgery or transplantation. While counterpulsation can indirectly help with hypotension and peripheral perfusion issues, these are secondary benefits resulting from improved left ventricular function rather than the primary indication for its use.
Some key points to consider when using counterpulsation for left ventricular failure include:
- The use of IABP is recommended only in the presence of haemodynamic impairment, as stated in the guidelines on myocardial revascularization 1.
- The benefits of an IABP should be balanced against device-related complications, mostly vascular and more frequently observed in small stature patients and/or females, patients with peripheral arterial disease (PAD), and diabetics 1.
- An IABP should not be used in patients with aortic insufficiency or aortic dissection, as noted in the guidelines on the diagnosis and treatment of acute heart failure 1.
- The IABP-Shock II trial found that the use of an IABP was not associated with a reduction in 30-day all-cause mortality compared with conservative care in patients with acute myocardial infarction complicated by cardiogenic shock 1.
Overall, the use of counterpulsation, particularly through IABP, is a valuable therapeutic approach for patients with left ventricular failure, especially those with cardiogenic shock or severe acute left heart failure that does not respond to other treatments 1.
From the Research
Counterpulsation Utilization
- Counterpulsation is most frequently utilized to assist patients suffering from left ventricular failure, as evidenced by studies 2, 3, 4, 5, 6.
Conditions Treated by Counterpulsation
- Left ventricular failure is a primary condition treated by counterpulsation, with intra-aortic balloon pump (IABP) counterpulsation being used to increase coronary blood flow and decrease afterload 2, 3, 4, 5, 6.
- Other conditions that may be treated by counterpulsation include cardiogenic shock, mechanical complications of myocardial infarction, intractable ventricular arrhythmias, and advanced heart failure 2, 3, 5.
Effects of Counterpulsation
- Counterpulsation has been shown to increase cardiac output, ejection fraction, coronary cerebral and renal blood flow, lactate utilization, and myocardial oxygen supply, while decreasing systolic aortic pressure, left-ventricular end-diastolic pressure, left-ventricular work, tension time index, myocardial oxygen consumption, and lactate production 4.
- Counterpulsation may also improve cerebral perfusion in patients with decreased left ventricular function 6.