Related Experiment Video
Updated: Jul 31, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Concomitant intra-aortic balloon pump and veno-arterial extracorporeal membrane oxygenation for postcardiotomy
Amr A Arafat1,2, Abdulmalik A Almedimigh1, Khaled D Algarni1
1Adult Cardiac Surgery Department, Prince Sultan Cardiac Center, Riyadh, Saudi Arabia.
Insights
This study found no significant difference in outcomes for patients on extracorporeal membrane oxygenation (ECMO) with or without intra-aortic balloon pump (IABP) support for postcardiotomy cardiogenic shock. Routine IABP use during ECMO is not supported by these findings.
Area of Science:
- Cardiology
- Cardiothoracic Surgery
- Intensive Care Medicine
Background:
- Post-cardiotomy cardiogenic shock is a severe complication following cardiac surgery.
- Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for refractory cardiogenic shock.
- The role of intra-aortic balloon pump (IABP) in conjunction with ECMO for postcardiotomy cardiogenic shock remains debated.
Purpose of the Study:
- To compare the clinical outcomes of postcardiotomy cardiogenic shock patients treated with ECMO with versus without IABP support.
- To evaluate the impact of IABP on hospital complications, successful weaning, and survival rates in this patient population.
Main Methods:
- A retrospective study of 103 patients requiring ECMO for postcardiotomy cardiogenic shock.
- Patients were divided into two groups: ECMO without IABP (n=43) and ECMO with IABP (n=60).
- Comparison of hospital complications, successful weaning rates, and survival between the two groups.
Main Results:
- Patients receiving IABP had a significantly lower preoperative ejection fraction (p=0.002).
- No significant differences were observed in stroke rates (p=0.97), limb ischemia (p=0.32), or ICU stay duration (p=0.11).
- Successful weaning rates were non-significantly higher in the IABP group (60% vs 44.19%, p=0.11), while survival rates showed no difference (p=0.80).
Conclusions:
- The addition of IABP to ECMO support for postcardiotomy cardiogenic shock did not demonstrate a significant benefit in terms of complications, weaning, or survival.
- Predictors of successful weaning included lower pre-ECMO lactate, absence of active endocarditis, younger age, and no aortic valve replacement.
- These findings do not support the routine use of IABP in conjunction with ECMO for postcardiotomy cardiogenic shock.
Abstract:
We aimed to compare the outcomes of ECMO with and without IABP for postcardiotomy cardiogenic shock. The study included 103 patients who needed ECMO for postcardiotomy cardiogenic shock. Patients were grouped according to the use of IABP into ECMO without IABP (n = 43) and ECMO with IABP (n = 60). The study endpoints were hospital complications, successful weaning, and survival. Patients with IABP had lower preoperative ejection fraction (p = 0.002). There was no difference in stroke (p = 0.97), limb ischemic (p = 0.32), and duration of ICU stay (p = 0.11) between groups. Successful weaning was non-significantly higher with IABP (36 (60%) vs 19 (44.19%); p = 0.11). Predictors of successful weaning were inversely related to the high pre-ECMO lactate levels (OR: 0.89; p = 0.01), active endocarditis (OR: 0.06; p = 0.02), older age (OR: 0.95; p = 0.02), and aortic valve replacement (OR: 0.26; p = 0.04). There was no difference in survival between groups (p = 0.80). Our study did not support the routine use of IABP during ECMO support.
Related Concept Videos
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management
01:29Cardiomyopathy V: Interprofessional Care
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:22Cardiopulmonary Resuscitation II: ACLS Airway Management