Intra-Aortic Balloon Pump during Cardiogenic Shock

Abstract

Intra-aortic ballon pump (IABP) was developed during the 1960’s, with the idea to increase cardiac output and coronary perfusion in cardiogenic shock patients. These effects were confirmed by physiological studies, although of smaller magnitude than expected. Considered initially as a salvage therapy, IABP was largely used and strongly recommended until recently in the setting of cardiogenic shock following myocardial infarction. However, these recommendations were mainly based on studies with heterogeneous results and low methodology level (cohort studies or small randomized trials). The large multicenter randomized IABP SHOCK II trial failed to demonstrate any advantage of the IABP during acute myocardial infarction complicated with cardiogenic shock. Following the publication of that trial, IABP is not recommended anymore routinely in this pathology. Similarly, although preliminary studies suggested better outcomes with peri-operative IABP in coronary artery bypass surgery, more recent randomized trials failed to confirm any effect in this setting. Lastly, one of the remaining indication for the IABP is its potential use in patients supported by peripheral veno-arterial ECMO, to partially unload the left ventricle and therefore reduce the risk of pulmonary oedema related to the increased in left ventricular afterload induced by VA-ECMO.