[Intra-aortic balloon pump (IABP) counterpulsation. Do we still need it and if so when?]

Intra-aortic balloon pump (IABP) counterpulsation was for a long time considered to be an indispensable standard for support of drug therapy for all forms of acute left-sided cardiac failure and especially in cardiogenic shock due to infarction. The advantages of the system seemed to be obvious; however, many of the postulated effects on the hemodynamics, microcirculation and coronary perfusion could not be confirmed later in prospective studies. It was found that IABP had no influence on microcirculation disorders in cardiogenic shock due to infarction. In a meta-analysis on the application for acute myocardial infarction without shock, no effect was found on mortality. The benefit as adjunct therapy for percutaneous coronary interventions (PCI) in cardiogenic shock due to infarction places a question mark over both IABP-SHOCK studies; however, in constellations without PCI the additional benefit of IABP cannot be excluded which is why the procedure could be an option in this situation.