Vascular Complications With Intra-aortic Balloon Pump (IABP): Experience From a Large Canadian Metropolitan Centre

Intra-aortic balloon pump (IABP) insertion in critically ill patients has been associated with both vascular and nonvascular complications, which have restricted its use. The primary objective for this study was to determine the frequency and predictors of vascular complication in our centre.

We conducted a retrospective cohort study of consecutive patients treated with an IABP between January 2014 and June 2018. Baseline clinical characteristics, cannulation details, duration of treatment and management, overall mortality, and complications were extracted from electronic and paper medical records.

A total of 187 patients required an IABP; of these, 146 were male (78.1%), the average age was 65.2 ± 11.5 years, and body mass index was 26.8 ± 6.2 kg/m². A majority of the patients had an IABP inserted in either the cardiac catheterization laboratory (54.5%) or an outside hospital (26.7%). The main indications for insertion were acute decompensated heart failure-cardiogenic shock (58.3%), followed by acute myocardial infarction and cardiogenic shock (26.2%). From the documented cannulation site, the right femoral artery was cannulated in 61.6% of patients, with a median size of 7.5 Fr (range: 5 -12 Fr). Mortality for in-hospital, 30-day, and 1-year mortality was calculated at 37.4%, 40.6%, and 41.7%, respectively. Limb ischemia (3.2%), bleeding (1.6%), mesenteric ischemia (0.5%), compartment syndrome (0.5%), and fasciotomy (0.5%), were rare occurrences. No records indicated amputation, aortoiliac dissection, thrombectomy, or infection at the site of insertion.

This single-centre retrospective study demonstrated that more than one third of this patient population died secondary to their primary diagnosis. The incidence of vascular complications secondary to IABP insertion remained low, with less than 3% developing an ischemic limb.