What is the optimum method of weaning intra-aortic balloon pumps?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: is weaning an intra-aortic balloon pump by volume superior to ratio reduction in terms of failure of weaning, inotropic support and haemodynamic parameters? A total of 667 papers were identified as a result of the search described below. Six papers were relevant to the question asked. The author, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses of the papers are tabulated. Little published evidence exists, although weaning by ratio is more common particularly in high-volume centres. The published data highlight the heterogeneity of weaning protocols not only between countries but also between hospitals in the same country. Current evidence is unable to establish any difference in clinical outcomes including mortality, reinsertion of intra-aortic balloon pumps and requirement for inotropic support between weaning by ratio, volume weaning and abrupt cessation. Despite this, the only randomized trial demonstrates improved haemodynamic profiles in those weaned by volume weaning. In addition, given the difficulty in obtaining clear clinical outcomes, N-terminal pro-brain natriuretic peptide and central venous oxygen saturation may be useful as surrogate markers for successful weaning.