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Interhospital transport of patients with ongoing intraaortic balloon pumping
Insights
Interhospital transfer of patients on continuous intraaortic balloon pumping is safe and effective for various cardiac conditions, not just cardiogenic shock. This approach facilitates necessary cardiac operations, improving patient outcomes.
Area of Science:
- Cardiovascular Surgery
- Critical Care Medicine
- Interventional Cardiology
Background:
- Continuous intraaortic balloon (IAB) pumping is a critical support method for patients with severe cardiac conditions.
- Transferring these hemodynamically unstable patients between hospitals poses significant logistical and clinical challenges.
- The safety and efficacy of transferring patients requiring IAB support for cardiac surgery have been historically debated.
Purpose of the Study:
- To evaluate the safety and outcomes of interhospital transfer for patients undergoing continuous intraaortic balloon pumping prior to cardiac surgery.
- To assess the range of indications for preoperative IAB insertion and transfer.
- To determine the feasibility of this transfer strategy across diverse patient populations.
Main Methods:
- A retrospective review of 50 consecutive patients who underwent interhospital transfer with continuous IAB pumping between 1979 and 1983.
- Patients were transferred from Evanston Hospital to Northwestern Memorial Hospital for cardiac operations.
- Data collected included indications for IAB, transfer process, surgical procedures, and postoperative outcomes, including complications.
Main Results:
- All 50 patients were successfully transferred and underwent cardiac operations, including coronary revascularization and other cardiac procedures.
- The overall postoperative mortality rate was 5% (3 patients).
- Complications directly related to IAB insertion occurred in 20% of patients, with various types of ischemia and bleeding reported.
Conclusions:
- Interhospital transfer of patients on continuous intraaortic balloon pumping is a safe and feasible strategy.
- The use of IAB pumping and subsequent transfer should not be limited to patients in cardiogenic shock but can be extended to other high-risk cardiac surgical candidates.
- This approach enables timely surgical intervention for a broader spectrum of critically ill cardiac patients.
Abstract:
During a 5-year period (1979 to 1983), 50 consecutive patients undergoing continuous intraaortic balloon (IAB) pumping were transferred from Evanston Hospital to Northwestern Memorial Hospital (16 miles), where they underwent cardiac operation. All patients had cardiac catheterization before transfer. Indications for IAB were cardiogenic shock (9 patients), postinfarction angina (18 patients), unstable angina (9 patients), evolving myocardial infarction (3 patients), accelerating angina or hemodynamic instability during cardiac catheterization (9 patients) and prophylactic insertion for high-grade left main stenosis (2 patients). Transportation after stabilization was uneventful in all patients. All patients underwent operative coronary revascularization. There was concomitant mitral valve replacement in 3 patients, acute ventricular septal defect repair in 1 patient, aortic valve replacement in 1, and ventricular aneurysmectomy in 1. Three patients (5%) died postoperatively. Nine patients (20%) had complications directly related to IAB insertion. One patient required femoral-femoral arterial bypass preoperatively, 4 patients had postoperative lower limb ischemia treated by IAB removal or thrombectomy and 1 patient had thrombocytopenia (less than 60,000/mm3), 1 false aneurysm, 1 anterior compartment syndrome and 1 prolonged bleeding at the insertion site. Interhospital transfer with IAB pumping in progress should not be restricted to patients with cardiogenic shock, but can be effectively used for all patients who require preoperative IAB insertion.(ABSTRACT TRUNCATED AT 250 WORDS)