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Updated: Nov 4, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Influence of intra-aortic balloon pump on mortality as a function of cardiogenic shock severity
Jacob C Jentzer1,2, Sean van Diepen3, Timothy D Henry4
1Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Insights
Intra-aortic balloon pump (IABP) use in cardiogenic shock (CS) patients is associated with lower in-hospital mortality. This survival benefit was observed across all severity stages of CS, indicating consistent efficacy.
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Devices
Background:
- Previous studies on intra-aortic balloon pump (IABP) in cardiogenic shock (CS) lacked severity stratification.
- Current research gap exists regarding IABP efficacy across different CS severities.
Purpose of the Study:
- To investigate the association between IABP use and in-hospital mortality in CS patients.
- To evaluate IABP's impact across various stages of CS severity, defined by the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages.
Main Methods:
- Analysis of 934 cardiac intensive care unit patients with CS from 2007-2015.
- Utilized multivariable logistic regression with inverse probability of treatment weighting (IPTW).
- Examined in-hospital mortality in relation to IABP use within each SCAI shock stage (B, C, D, E).
Main Results:
- IABP use in 39% of patients was linked to significantly lower in-hospital mortality (27% vs. 43%).
- Adjusted odds ratio for mortality with IABP was 0.53 (95% CI 0.40-0.72, p < .0001).
- Lower mortality with IABP was consistent across all SCAI shock stages, with no significant heterogeneity observed.
Conclusions:
- IABP use in CS patients is associated with reduced in-hospital mortality.
- The effectiveness of IABP in improving survival does not differ significantly across CS severity stages.
- Future research should consider shock severity and etiology when assessing IABP efficacy in CS.
Background:
Randomized studies of intra-aortic balloon pump (IABP) in cardiogenic shock (CS) have only included on patients with acute coronary syndromes (ACS) without stratification according to shock severity. We examined the association between IABP and mortality in CS patients across the Society for Cardiovascular Angiography and Intervention (SCAI) shock stages.
Methods:
We included cardiac intensive care unit patients admitted from 2007 to 2015 with CS from any etiology. In-hospital mortality associated with IABP was examined in each SCAI shock stage. Multivariable logistic regression was performed using inverse probability of treatment weighting (IPTW) to determine the association between IABP and in-hospital mortality.
Results:
We included 934 patients, with a mean age of 68 ± 14 years; 60% had ACS. The distribution of SCAI shock stages was: B, 41%; C, 13%; D, 38%; E, 8%. In-hospital mortality was lower in the 39% of patients who received IABP (27% vs. 43%, adjusted OR with IABP after IPTW 0.53, 95% CI 0.40-0.72, p < .0001). IABP use was associated with lower crude in-hospital mortality in each SCAI shock stage (all p < .05, except p = .08 in SCAI shock stage E). We did not observe any significant heterogeneity in the association between IABP use and in-hospital mortality as a function of SCAI shock stage.
Conclusions:
Patients with CS who were selected to receive an IABP had lower in-hospital mortality, without differences in this effect across the SCAI shock stages. Future studies should account for the severity and etiology of shock when evaluating the efficacy of IABP for CS.
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