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Intraaortic balloon pumping in children
C Akomea-Agyin1, N K Kejriwal, R Franks
1Department of Cardiac Surgery, Royal Liverpool Children's Hospital-Alder Hey, England.
Insights
Intra-aortic balloon pump (IABP) therapy can be a life-saving option for children with refractory cardiac failure after heart surgery. This study shows IABP use in pediatric cardiac surgery patients offers over 50% long-term survival.
Area of Science:
- Pediatric Cardiac Surgery
- Mechanical Circulatory Support
- Cardiology
Background:
- Intra-aortic balloon pump (IABP) use in pediatric patients is uncommon due to misconceptions about aortic elasticity and concerns for right ventricular failure.
- Children requiring mechanical support after cardiac surgery often present with complex conditions, including refractory cardiac failure.
Purpose of the Study:
- To evaluate the efficacy and outcomes of intra-aortic balloon pump (IABP) support in pediatric patients following cardiac surgery.
- To assess the feasibility of IABP as a mechanical support in young children with refractory low cardiac output states.
Main Methods:
- A retrospective review of 14 pediatric patients who received IABP support after cardiac surgery over a 3-year period.
- Analysis of indications for IABP use, patient demographics (median age 3 years, median weight 13.3 kg), and outcomes including survival and complications.
Main Results:
- 71% (10 of 14) of patients were successfully weaned from IABP support.
- 57% (8 of 14) achieved long-term survival, with a mean IABP duration of 127 hours in survivors.
- Mesenteric ischemia was the most significant IABP-related complication, resulting in a fatal outcome in one case.
Conclusions:
- Intra-aortic balloon pump (IABP) therapy, as an adjunct to conventional treatment, offers a significant chance of long-term survival for carefully selected pediatric patients with refractory low cardiac output after heart surgery.
- IABP can be a viable mechanical support option in pediatric cardiac surgery, challenging previous reservations about its use in this population.
Background:
Intraaortic balloon pump (IABP) usage in young children remains a rarity because, first, there is a widespread misconception that the greater elasticity of the aorta in children may prevent effective augmentation, and second, children in low cardiac output states are more likely to have associated right ventricular failure and pulmonary problems. We report our experience with the use of IABP in children undergoing cardiac surgery in whom mechanical support was necessary for the treatment of refractory cardiac failure.
Methods:
Over a 3-year period, 14 children were identified as requiring IABP support after cardiac surgery. Their median age was 3 years (range 7 days to 13 years) and their median weight was 13.3 kg (range 3.5-51 kg). Indications for IABP use were: failure to wean from cardiopulmonary bypass (5 patients), sudden deterioration in intensive therapy unit (ITU) (3 patients), progressive deterioration in ITU (4 patients), and prophylactic therapy for known poor preoperative ventricular function (2 patients).
Results:
Ten of 14 patients (71%) were successfully weaned from the IABP, of whom 8 became long-term survivors (57%). Among the survivors, the mean duration of IABP usage was 127 h (range 12-260 h), while for those who died while on IABP, the mean duration was 15 h (range 8-24 h). The most major IABP-related complication encountered was mesenteric ischemia, which had a fatal outcome.
Conclusions:
IABP therapy, used as an adjunct to conventional medical treatment, can give properly selected young children in refractory low cardiac output states after heart surgery a greater than 50% chance of long-term survival.
