Biomaterial Database

Intra-Aortic Balloon Pump (IABP) in cardiogenic shock. 2013

Georg Fuernau, and Holger Thiele

Department of Internal Medicine/Cardiology, University of Leipzig - Heart Center, Leipzig, Germany.

OBJECTIVE Despite developments in treatment of myocardial infarction, mortality rates in cardiogenic shock remain unacceptably high. Intra-aortic balloon pumping (IABP) is to date the most used device for hemodynamic support, but randomized evidence on survival benefit was lacking. RESULTS A recently published meta-analysis with hints for higher mortality after primary percutaneous intervention challenged the previous high-grade recommendations for IABP. Therefore the use in cardiogenic shock was downgraded in the last versions of European and American guidelines from a class I to a class IIa and IIb recommendation, respectively. Furthermore, a large scale randomized trial found no benefit on 30-day mortality in patients with myocardial infarction complicated by cardiogenic shock. This result was supported by a lack of difference in all subgroups and secondary endpoints. CONCLUSIONS In cardiogenic shock, no general recommendation for IABP can be given. In the next revision of current guidelines, recent randomized trial results should be incorporated. Further research is needed to develop optional treatments in cardiogenic shock or to gain validated algorithms for use of active assist devices.

UI	MeSH Term	Description	Entries
D007423	Intra-Aortic Balloon Pumping	Counterpulsation in which a pumping unit synchronized with the patient's electrocardiogram rapidly fills a balloon in the aorta with helium or carbon dioxide in early diastole and evacuates the balloon at the onset of systole. As the balloon inflates, it raises aortic diastolic pressure, and as it deflates, it lowers aortic systolic pressure. The result is a decrease in left ventricular work and increased myocardial and peripheral perfusion.	Pumping, Intra-Aortic Balloon,Intraaortic Balloon Pumping,Balloon Pumping, Intra-Aortic,Balloon Pumping, Intraaortic,Intra Aortic Balloon Pumping,Pumping, Intra Aortic Balloon,Pumping, Intraaortic Balloon
D006439	Hemodynamics	The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM.	Hemodynamic
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D012770	Shock, Cardiogenic	Shock resulting from diminution of cardiac output in heart disease.	Cardiogenic Shock
D016032	Randomized Controlled Trials as Topic	Works about clinical trials that involve at least one test treatment and one control treatment, concurrent enrollment and follow-up of the test- and control-treated groups, and in which the treatments to be administered are selected by a random process, such as the use of a random-numbers table.	Clinical Trials, Randomized,Controlled Clinical Trials, Randomized,Trials, Randomized Clinical
D017410	Practice Guidelines as Topic	Works about directions or principles presenting current or future rules of policy for assisting health care practitioners in patient care decisions regarding diagnosis, therapy, or related clinical circumstances. The guidelines may be developed by government agencies at any level, institutions, professional societies, governing boards, or by the convening of expert panels. The guidelines form a basis for the evaluation of all aspects of health care and delivery.	Clinical Guidelines as Topic,Best Practices,Best Practice