[ANMCO Position paper: Current evidence on intra-aortic balloon pump in advanced acute heart failure]

Area of Science:

• Cardiology
• Cardiovascular Medicine
• Critical Care Medicine

Background:

• Advanced acute heart failure and cardiogenic shock present significant treatment challenges.
• Intra-aortic balloon pump (IABP) has been a common intervention for cardiogenic shock.
• International guidelines now question the routine use of IABP based on trial evidence.

Purpose of the Study:

• To review existing clinical data on Intra-aortic balloon pump (IABP) efficacy.
• To provide practical recommendations for the optimal use of IABP in cardiogenic shock and advanced acute heart failure.
• To present data from a national survey on IABP utilization in Italian hospitals.

Main Methods:

• Review of clinical studies on Intra-aortic balloon pump (IABP) in acute heart failure and cardiogenic shock.
• Analysis of data from the IABP-SHOCK II trial regarding mortality outcomes.
• Inclusion of findings from a national survey on IABP use in Italian healthcare settings.

Main Results:

• The IABP-SHOCK II trial indicated no reduction in all-cause mortality with IABP in acute myocardial infarction with cardiogenic shock.
• Current international guidelines do not support the routine use of IABP for cardiogenic shock.
• A national survey provides insights into current IABP practices in Italy.

Conclusions:

• While not recommended for routine use, optimal application of IABP may still be beneficial in specific scenarios of advanced acute heart failure and cardiogenic shock.
• This position paper offers guidance for judicious IABP use.
• Further evaluation of IABP's role in selected patient populations is warranted.