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Intraaortale Gegenpulsation (IABP)

Brauchen wir sie noch und wenn ja wann?

Intra-aortic balloon pump (IABP) counterpulsation

Do we still need it and if so when?

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Zusammenfassung

Die intraaortale Gegenpulsationspumpe (IABP) galt lange Zeit als unabkömmlicher Standard zur Unterstützung der medikamentösen Therapie bei allen Formen des akuten linkskardialen Versagens, insbesondere im infarktbedingten kardiogenen Schock. Die Vorteile des Systems schienen offensichtlich, doch viele der postulierten Effekte auf Hämodynamik, Mikrozirkulation und Koronarperfusion ließen sich später in prospektiven Studien nicht bestätigen. So hat die IABP im infarktbedingten kardiogenen Schock keinen Einfluss auf Mikrozirkulationsstörungen. In einer Metaanalyse zur Anwendung bei akutem Myokardinfarkt ohne Schock fand sich kein Effekt auf die Mortalität. Den Nutzen als adjunktive Therapie bei perkutaner Koronarintervention (PCI) im infarktbedingten kardiogenen Schock stellen die beiden IABP-SHOCK-Studien infrage. Aktuell gibt es keine Evidenz für die IABP-Insertion im Rahmen der PCI. In Konstellationen ohne PCI ist ein Zusatznutzen der IABP aber nicht auszuschließen, weshalb das Verfahren hier eine Option sein kann.

Abstract

Intra-aortic balloon pump (IABP) counterpulsation was for a long time considered to be an indispensable standard for support of drug therapy for all forms of acute left-sided cardiac failure and especially in cardiogenic shock due to infarction. The advantages of the system seemed to be obvious; however, many of the postulated effects on the hemodynamics, microcirculation and coronary perfusion could not be confirmed later in prospective studies. It was found that IABP had no influence on microcirculation disorders in cardiogenic shock due to infarction. In a meta-analysis on the application for acute myocardial infarction without shock, no effect was found on mortality. The benefit as adjunct therapy for percutaneous coronary interventions (PCI) in cardiogenic shock due to infarction places a question mark over both IABP-SHOCK studies; however, in constellations without PCI the additional benefit of IABP cannot be excluded which is why the procedure could be an option in this situation.

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Authors and Affiliations

  1. Kardiologie und Pneumologie, Helios Amper-Klinikum, Krankenhausstr. 15, 85221, Dachau, Deutschland

    M. Russ

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A. Geppert, Wien

G. Heinz, Wien

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Russ, M. Intraaortale Gegenpulsation (IABP). Med Klin Intensivmed Notfmed 110, 402–406 (2015). https://doi.org/10.1007/s00063-015-0064-5

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  • DOI: https://doi.org/10.1007/s00063-015-0064-5

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