Outcomes among patients requiring unplanned intra-aortic balloon pump reinsertion in cardiogenic shock

The intra-aortic balloon pump (IABP) is the most frequently utilized form of temporary mechanical circulatory support (MCS) in cardiogenic shock (CS). Withdrawal of IABP support may precipitate hemodynamic compromise such that IABP reinsertion is required. Data are scarce regarding the incidence and outcomes of patients undergoing IABP reinsertion in this setting.

In this single-center retrospective study, we identified consecutive patients with CS in whom IABP reinsertion was required for hemodynamic decompensation. These patients were compared to matched controls in whom IABP withdrawal was successful. The primary outcome measure was in-hospital mortality, while the secondary outcome measure was a composite of in-hospital death, need for advanced MCS or heart transplantation, or discharge to hospice.

Among 222 patients requiring IABP for CS, we identified 20 case patients (incidence=9.0%) and 38 matched controls. Baseline characteristics were similar for the two groups. In-hospital mortality was 70% in the reinsertion group and 31% in the controls (Odds ratio (OR) 5.2, 95% CI 1.4-18.9, P=0.005). The composite secondary endpoint was also significantly more common in the reinsertion group than the controls (85% vs. 42%; OR 7.3, 95% CI 1.6-33.1, P=0.002). On multivariate analysis, the need for IABP reinsertion was independently associated with in-hospital mortality (OR 7.7, 95% CI 1.6-36.2, P=0.01).

Among patients with CS undergoing IABP removal, hemodynamic deterioration requiring IABP reinsertion is associated with extremely poor outcomes and, in appropriate patients, should prompt consideration of more advanced cardiac support.