Complications associated with intra-aortic balloon pump treatment in critically ill patients: A systematic review

In recent decades, intra-aortic balloon pump (IABP) technology has made significant progress (sheathless insertion technique, different balloon diameters, percutaneous technique and fibre optic IABP) in reducing complications and increasing patient support. Nonetheless, IABP-related complications are still frequent and are associated with a poor prognosis.

The aim of this systematic review was to identify complications associated with IABP treatment in critically ill patients with a compromised cardiac function.

A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines based on searches in CINAHL (EBSCO), Medline and Embase (Ovid) from January 2012 to April 2023. Quantitative studies were included if they reported as their primary outcome(s) complications of IABP in adult patients because of cardiovascular conditions and were published in English, Norwegian, Swedish or Danish. Study selection, methodological quality assessment and data extraction were performed independently by two authors. The results were synthesized narratively.

A total of nine studies were included in the review, most of which were retrospective (eight of nine). Bleeding was the most frequently occurring complication, followed by limb ischaemia, stroke, infection, IABP malfunction, haematoma and other vascular complications. In addition, a correlation between IABP duration and vascular complications was found in three out of nine studies. Lastly, the incidence rate of stroke was higher in patients with axillary IABP than in those with femoral IABP.

This systematic review revealed that bleeding and limb ischaemia were the two most frequent complications associated with IABP therapy. We identified a correlation between (a) IABP support time and the development of vascular complications and (b) stroke and implantation of IABP catheter in the axillary artery. Further studies are needed to explore these findings directly.

Increasing critical care nurses' knowledge regarding complications related to IABP support could lead to early identification, potentially lowering the incidence rate of complications.