Related Experiment Video
Updated: Sep 10, 2025
The Intra-Aortic Balloon Pump
Published on: February 5, 2021
Comparison of Heart Failure Cardiogenic Shock Patients with Axillary and Femoral Intra-aortic Balloon Pump:
Arvind Bhimaraj1, Arthur R Garan2, Qiuyue Kong3
1Methodist DeBakey Cardiology Associates, Houston Methodist Hospital, Houston, Texas.
Insights
Axillary intra-aortic balloon pump (IABP) use in heart failure patients with cardiogenic shock is increasing. This study found similar complication rates between axillary and femoral IABP, with axillary placement often serving as a bridge to heart replacement.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Critical Care Medicine
Background:
- Intra-aortic balloon pumps (IABPs) are crucial in managing cardiogenic shock.
- Traditionally, IABPs are inserted via the femoral artery.
- Axillary IABP placement has shown promise for ambulation in smaller studies, but its utility in cardiogenic shock (CS) remains less established.
Purpose of the Study:
- To evaluate the outcomes of patients with heart failure-related cardiogenic shock (HF-CS) treated with axillary (Ax) IABP.
- To compare these outcomes with patients who received femoral (Fem) IABP.
Main Methods:
- A multi-center analysis of data from the Cardiogenic Shock Working Group (CSWG) registry (2020-2023).
- Demographic, metabolic, and hemodynamic characteristics and outcomes were compared between HF-CS patients receiving Ax-IABP versus Fem-IABP.
Main Results:
- Of 557 IABP patients for HF-CS, 244 received Ax-IABP and 313 received Fem-IABP.
- Ax-IABP patients had a higher likelihood of prior intra-cardiac defibrillators (68.9% vs 42.5%) and longer times to implant and support duration.
- Ax-IABP patients were more likely to undergo heart replacement therapy (65% vs 21%), with similar complication rates between groups.
Conclusions:
- Axillary IABP is increasingly used for HF-CS, often as a bridge to heart replacement therapies.
- Axillary IABP may offer advantages in managing HF-CS compared to femoral IABP, with comparable safety profiles.
Background:
IABPs traditionally are placed via the femoral artery. Single-center studies have shown the utility of axillary placement to promote ambulation. The utility of Ax IABP in CS has not been established. Therefore, we sought to describe the outcomes of patients receiving axillary (Ax) intra-aortic balloon pump (IABP) and compare them with those receiving femoral (Fem) IABP for heart failure-related cardiogenic shock (HF-CS).
Methods:
Data from 2020 to 2023 from the Cardiogenic Shock Working Group, a multicenter academic consortium, were analyzed. We examined the demographic, metabolic, hemodynamic characteristics, and outcomes of patients with HF-CS treated with Ax-IABP and compared them with those who primarily received a Fem-IABP.
Results:
Of 6201 CS patients in the registry, 557 (8.9%) patients received an IABP for HF-CS, of whom 244 (43.8%) and 313 (56.2%) received Ax-IABP and Fem-IABP, respectively. Compared with Fem-IABP, patients who received Ax-IABP were more likely to have previous intracardiac defibrillators (42.5% vs 68.9%, P < .001). Time to IABP implant from admission (7.9 ± 10.6 vs 1.8 ± 6.1, P < .01) and duration of support (9.6 ± 14.6 vs 4.0 ± 4.5, P < .01) were longer among Ax-IABP, relative to Fem-IABP. Patients who received Ax-IABP were more likely to undergo heart-replacement therapy (65% vs 21%, P < .001) compared with the Fem-IABP cohort. The rate of reported complications was similar between the 2 groups.
Conclusion:
Axillary IABP is being used beyond single-center reports to support HF-CS mostly as a bridge to heart-replacement therapies. Its use might provide advantages over fem-IABP.
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