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Current results with intraaortic balloon pumping in infants and children
Kerrie A Pinkney1, L Luann Minich, Lloyd Y Tani
1Department of Pediatrics, Primary Children's Medical Center, University of Utah, Salt Lake City 84113, USA.
Insights
Intra-aortic balloon pumping (IABP) effectively supports children with left ventricular dysfunction. Echocardiography-timed IABP shows similar survival rates to electrocardiogram timing, suggesting its utility in pediatric cardiac care.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Support
- Medical Device Technology
Background:
- Intra-aortic balloon pumping (IABP) is a recognized support method for moderate left ventricular dysfunction.
- Traditional IABP timing uses the electrocardiogram's R wave, which may be less suitable for children due to higher heart rates.
- M-mode echocardiography has been used for IABP timing in pediatric left-side heart failure since 1994.
Purpose of the Study:
- To evaluate the experience with intra-aortic balloon pumping (IABP) in children.
- To compare outcomes of IABP therapy timed by M-mode echocardiography versus electrocardiogram timing in pediatric patients.
- To assess the effectiveness of echocardiography-guided IABP in pediatric left ventricular dysfunction.
Main Methods:
- A retrospective review of 29 children who received IABP for various indications between 1988 and the present.
- Comparison of survival rates between infants and older children.
- Analysis of survival rates comparing the period before 1994 (electrocardiogram timing) and after 1994 (echocardiography timing).
Main Results:
- Overall survival in the study cohort was 62.1% (18 out of 29 patients).
- Survival rates were comparable between infants and older children (OR = 2.0, p = 0.43).
- Survival rates were similar in the echocardiography timing era compared to the electrocardiogram timing era (OR = 2.4, p = 0.44).
Conclusions:
- Intra-aortic balloon pumping (IABP) serves as a valuable support modality for pediatric patients experiencing left ventricular dysfunction.
- M-mode echocardiography is an effective method for triggering IABP in children.
- The study's sample size is insufficient to definitively conclude a difference in mortality rates between the timing methods.
Background:
Intraaortic balloon pumping (IABP) is useful for support in patients with moderate left ventricular dysfunction. IABP is usually timed with the R wave of the electrocardiogram. We have utilized M-mode echocardiography timed IABP in children with left-side heart failure since 1994. Electrocardiogram timing seems inappropriate for children, who have much higher heart rates. We describe our experience with children who underwent IABP therapy before and after 1994, when echocardiographic timing was instituted.
Methods:
We reviewed records of 29 children who underwent IABP for all indications at Primary Children's Medical Center since 1988.
Results:
Overall survival was 62.1% (18 of 29) in this series. Survival was similar for infants (odds ratio = 2.0, 95% confidence interval = 0.29 to 14.31, p = 0.43) and older children. Survival was similar in the echocardiography era when compared with the electrocardiogram era (odds ratio = 2.4, 95% confidence interval = 0.56 to 10.4, p = 0.44).
Conclusions:
IABP is a useful means of support in children with left ventricular dysfunction. M-mode echocardiography is effective in triggering IABP. The sample size in this study is too small to detect a mortality rate difference.