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Updated: Jul 7, 2026
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Preoperative intra-aortic balloon pump in patients undergoing coronary bypass surgery: a systematic review and
Adel M Dyub1, Richard P Whitlock, Labib L Abouzahr
1Division of Cardiac Surgery, McMaster University, Hamilton, Ontario, Canada. dyubam@mcmaster.ca
Insights
Preoperative intra-aortic balloon pump (IABP) placement significantly reduces hospital mortality in high-risk patients undergoing coronary bypass surgery (CABG). This meta-analysis supports IABP use to improve outcomes for these vulnerable patients.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Evidence-Based Medicine
Background:
- Coronary artery bypass grafting (CABG) carries significant risks for high-risk patients.
- The role of preoperative interventions in mitigating these risks is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of preoperative intra-aortic balloon pump (IABP) placement in reducing hospital mortality.
- To assess IABP-related complications in patients undergoing CABG.
Main Methods:
- A systematic meta-analysis was performed, including randomized controlled trials and cohort studies.
- Searches were conducted across major databases (MEDLINE, EMBASE, Cochrane).
- Data extraction and validity assessment were done in duplicate, with meta-analysis using a random effects model.
Main Results:
- Ten studies involving 1034 patients receiving preoperative IABP and 1329 controls were analyzed.
- A pooled odds ratio of 0.41 (95% CI, 0.21-0.82) indicated reduced hospital mortality with preoperative IABP.
- IABP-related complications, such as limb ischemia or hematoma, occurred in 3.7% of patients and were mostly manageable.
Conclusions:
- The findings strongly support the use of preoperative IABP in high-risk CABG patients.
- Preoperative IABP is an effective strategy for reducing hospital mortality in this population.
- While complications exist, they are infrequent and generally manageable.
Objectives:
To assess the effectiveness of preoperative intra-aortic balloon pump (IABP) placement in high-risk patients undergoing coronary bypass surgery (CABG). The primary outcome was hospital mortality and secondary outcomes were IABP-related complications (bleeding, leg ischemia, aortic dissection).
Methods:
MEDLINE, EMBASE, Cochrane registry of Controlled Trials, and reference lists of relevant articles were searched. We included randomized controlled trials (RCTs), and cohort studies that fulfilled our a priori inclusion criteria. Eligibility decisions, relevance, study validity, and data extraction were performed in duplicate using pre-specified criteria. Meta-analysis was conducted using a random effects model.
Results:
Ten publications fulfilled our eligibility criteria, of which four were RCTs and six were cohort studies with controls. There were statistical as well as clinical heterogeneity among included studies. A total of 1034 patients received preoperative IABP and 1329 did not receive preoperative IABP. The pooled odds ratio (OR) for hospital mortality in patients treated with preoperative IABP was 0.41 (95% CI, 0.21-0.82, p = 0.01). The number needed to treat was 17. The pooled OR for hospital mortality from randomized trials was 0.18 (95% CI, 0.06-0.57, p = 0.003) and from cohort studies was 0.54 (95% CI, 0.24-1.2, p = 0.13). Overall, 3.7% (13 of 349) of patients who received preoperative IABP developed either limb ischemia or haematoma at the IABP insertion site, and most of these complications improved after discontinuation of IABP.
Conclusion:
Evidence from this meta-analysis support the use of preoperative IABP in high-risk patients to reduce hospital mortality.
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