What are the contraindications for an Intra-Aortic Balloon Pump (IABP)?

From the Guidelines

Intra-aortic balloon pumps (IABPs) are contraindicated in patients with severe aortic insufficiency, aortic dissection, and severe peripheral and aortic vascular disease, as stated in the most recent and highest quality study 1. The contraindications for intra-aortic balloon pump (IABP) therapy are primarily focused on conditions that could be worsened by the device's mechanism of action or where the risks of insertion and use outweigh the potential benefits.

Key Contraindications

• Severe aortic insufficiency: This condition is contraindicated for IABP use because the augmentation of aortic diastolic pressure can worsen the severity of the acute regurgitant volume, thereby aggravating left ventricular (LV) filling pressures and compromising forward output 1.
• Aortic dissection: The use of IABP in patients with aortic dissection is contraindicated due to the risk of further dissection or rupture of the aorta.
• Severe peripheral and aortic vascular disease: Patients with significant vascular disease are at increased risk for complications related to IABP insertion, including vascular injury or rupture.

Relative Contraindications

While not absolute, certain conditions may also represent relative contraindications for IABP therapy, including:

• Bleeding disorders or active bleeding, as IABP therapy requires anticoagulation
• Sepsis, which may worsen with foreign body insertion
• End-stage irreversible cardiac or other organ failure where temporary support would not change outcomes
• Prosthetic grafts in the descending aorta and severe thrombocytopenia These conditions require careful consideration and weighing of the potential risks and benefits of IABP therapy on a case-by-case basis. The most recent and highest quality evidence supports these contraindications, emphasizing the importance of careful patient selection to maximize the benefits of IABP therapy while minimizing its risks 1.

From the Research

Contraindications for Intra-Aortic Balloon Pump

• Severe peripheral vascular disease 2
• Aortic regurgitation 2
• Aortic dissection 2, 3
• Aortic aneurysm 2

Special Considerations

• Type A aortic dissection is traditionally considered a contraindication, but IABP may be used as a salvage option in cases of severe cardiogenic shock following type A aortic dissection 3
• IABP should be used with caution in patients with severe aortic stenosis presenting in cardiogenic shock, as it may improve haemodynamic profile but also carries risks of complications 4

Potential Complications

• Bleeding 2
• Systemic thromboembolism 2
• Limb ischemia 2, 5
• Death 2, 5
• Device-related complications such as technical malfunctioning, deep vein thrombosis, thrombocytopenia 4