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The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry
J J Ferguson1, M Cohen, R J Freedman
1Texas Heart Institute, Houston, Texas 77030, USA. jferguson@heart.thi.tmc.edu
Insights
This large registry of intra-aortic balloon pump (IABP) use shows low complication rates but high in-hospital mortality. Women, older patients, and those with peripheral vascular disease face increased complication risks.
Area of Science:
- Cardiology
- Medical Devices
- Clinical Research
Background:
- Intra-aortic balloon pump (IABP) provides circulatory support for hemodynamic instability.
- IABP is used in myocardial infarction, cardiogenic shock, and high-risk procedures like angioplasty or bypass grafting.
Purpose of the Study:
- To present clinical data from the first large registry of intra-aortic balloon counterpulsation.
- To analyze indications, demographics, outcomes, and complications of IABP use.
Main Methods:
- Prospective data collection from 203 hospitals worldwide between June 1996 and August 2000.
- 16,909 patient case records were analyzed, detailing IABP usage and patient characteristics.
Main Results:
- Most frequent indications: post-cardiac catheterization support (20.6%), cardiogenic shock (18.8%), weaning from bypass (16.1%).
- Major complications occurred in 2.6% of cases; in-hospital mortality was 21.2%.
- Female gender, advanced age, and peripheral vascular disease independently predicted serious complications.
Conclusions:
- The IABP registry is a valuable tool for monitoring clinical practice.
- IABP complication rates are low, but in-hospital mortality remains high.
- Increased risk of major complications is observed in women, older patients, and those with peripheral vascular disease.
Objectives:
This study presents clinical data from the first large registry of aortic counterpulsation, a computerized database that incorporates prospectively gathered data on indications for intra-aortic balloon counterpulsation (IABP) use, patient demographics, concomitant medication and in-hospital outcomes and complications.
Background:
The intra-aortic balloon pump (IABP) is widely used to provide circulatory support for patients experiencing hemodynamic instability due to myocardial infarction, cardiogenic shock, or in very high risk patients undergoing angioplasty or coronary artery bypass grafting.
Methods:
Between June 1996 and August 2000, 203 hospitals worldwide (90% U.S., 10% non-U.S.) collected 16,909 patient case records (68.8% men, 31.2% women; mean age 65.9 +/- 11.7 years).
Results:
The most frequent indications for use of IABP were as follows: to provide hemodynamic support during or after cardiac catheterization (20.6%), cardiogenic shock (18.8%), weaning from cardiopulmonary bypass (16.1%), preoperative use in high risk patients (13.0%) and refractory unstable angina (12.3%). Major IABP complications (major limb ischemia, severe bleeding, balloon leak, death directly due to IABP insertion or failure) occurred in 2.6% of cases; in-hospital mortality was 21.2% (11.6% with the balloon in place). Female gender, high age and peripheral vascular disease were independent predictors of a serious complication.
Conclusions:
This registry provides a useful tool for monitoring the evolving practice of IABP. In the modern-day practice of IABP, complication rates are generally low, although in-hospital mortality remains high. There is an increased risk of major complications in women, older patients and patients with peripheral vascular disease.