Intra-aortic Balloon Counterpulsation in Cardiogenic Shock

  • K. Werdan
  • M. Russ
  • M. Buerke
Part of the Yearbook of Intensive Care and Emergency Medicine book series (YEARBOOK, volume 2010)

Abstract

What can we expect from the implementation of an intra-aortic balloon counterpulsation pump (IABP) in a patient with shock (Fig. 1)? The conventional indication for IABP is cardiogenic shock of ischemic etiology. With the IABP in place in the thoracic aorta, inflation of the balloon in diastole and active deflation in systole induces higher perfusion pressures in the brain and the coronary arteries in diastole and unloads the diseased heart by reducing left ventricular afterload in systole. Of special relevance is the volume shifting of about 40 ml per beat by the IABP, increasing left ventricular ejection fraction and thereby cardiac output in the range of at best 1 l/min.
Fig. 1.

Patient with myocardial infarction complicated by cardiogenic shock. After treatment with primary percutaneous coronary intervention the patient is still under adjunctive therapy with the intra-aortic balloon counterpulsation (IABP). Written permission obtained from the patient

Keywords

Septic Shock Cardiogenic Shock Left Ventricular Assist Device STEMI Patient Percutaneous Coronary Intervention 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 1.
    The Task Force on the Management of ST-segment Elevation Acute Myocardial Infarction of the European Society of Cardiology (2008) Management of acute myocardial infarction in patients presenting with persistent ST-segment elevation. Eur Heart J 29: 2909–2945CrossRefGoogle Scholar
  2. 2.
    Antman EM, Hand M, Armstrong PW, et al (2008) 2007 focused update of the ACC/AHA 2004 Guidelines for the Management of Patients With ST-Elevation Myocardial Infarction: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 51: 210–247CrossRefPubMedGoogle Scholar
  3. 3.
    Stone GW, Ohman EM, Miller MF, et al (2003) Contemporary utilization and outcomes of intra-aortic balloon counterpulsation in acute myocardial infarction: The benchmark registry. J Am Coll Cardiol 41: 1940–1945CrossRefPubMedGoogle Scholar
  4. 4.
    Santarpino G, Onorati F, Rubino AS, et al (2009) Preoperative intraaortic balloon pumping improves outcomes for high-risk patients in routine coronary artery bypass graft surgery. Ann Thorac Surg 87: 481–488CrossRefPubMedGoogle Scholar
  5. 5.
    Hochman JS, Buller CE, Sleeper LA, et al (2000) Cardiogenic shock complicating acute myocardial infarction — etiologies, management and outcome: a report from the SHOCK Trial Registry. SHould we emergently revascularize Occluded Coronaries for Cardiogenic shocK? J Am Coll Cardiol 36: 1063–1070CrossRefPubMedGoogle Scholar
  6. 6.
    Prondzinsky R, Lemm H, Swyter M, et al (2010) Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock — The Prospective, Randomized IABP SHOCK Trial for Attenuation of Multi-Organ Dysfunction Syndrome. Crit Care Med 38: 152–160CrossRefPubMedGoogle Scholar
  7. 7.
    Werdan K, Pilz G, Bujdoso O, et al (2007) Score-based immunoglobulin G therapy of patients with sepsis: The SBITS study. Crit Care Med 35: 2693–2701CrossRefPubMedGoogle Scholar
  8. 8.
    Sjauw KD, Engstrom AE, Vis MM, et al (2009) A systematic review and meta-analysis of intraaortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines? Eur Heart J 30: 459–468CrossRefPubMedGoogle Scholar
  9. 9.
    Wilson SR, Mudge GH Jr, Stewart GC, Givertz MM (2009) Evaluation for a ventricular assist device — selecting the appropriate candidate. Circulation 119: 2225–2232CrossRefPubMedGoogle Scholar
  10. 10.
    Seyfarth M, Sibbing D, Bauer I, et al (2008) A randomized clinical trial to evaluate the safety and efficacy of a percutaneous left ventricular assist device versus intra-aortic balloon pumping for treatment of cardigenic shock caused by myocardial infarction. J Am Coll Cardiol 52: 1584–1588CrossRefPubMedGoogle Scholar
  11. 11.
    Combes A, Leprine P, Luyt C-E, et al (2008) Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock. Crit Care Med 36: 1404–1411CrossRefPubMedGoogle Scholar
  12. 12.
    Camboni D, Philipp A, Arlt M, Pfeiffer M, Hilker M, Schmid C (2009) First experience with a paracorporal artifical lung in humans. ASAIO J 55: 304–306CrossRefPubMedGoogle Scholar
  13. 13.
    Thiele H, Sick P, Boudriot E, et al (2005) Randomized comparison of intra-aortic balloon support with a percutaneous left ventricular assist device in patients with revascularized acute myocardial infarction complicated by cardiogenic shock. Eur Heart J 26: 1276–1283CrossRefPubMedGoogle Scholar
  14. 14.
    Chen YS, Lin JW, Yu H-Y, et al (2008) Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: an observational study and propensity analysis. Lancet 372: 554–561CrossRefPubMedGoogle Scholar
  15. 15.
    Ferrari M, Poerner TC, Brehm BR, et al (2008) First use of a novel plug-and-play percutaneous circulatory assist device for high-risk coronary angioplasty. Acute Card Care 10: 111–115CrossRefPubMedGoogle Scholar
  16. 16.
    Cheng JM, den Uil CA, Hoeke SE, et al (2009) Percutaneous left ventricular assist devices vs. intra-aortic balloon pump counterpulsation for treatment of cardiogenic shock: a meta-analysis of controlled trials. Eur Heart J 30: 2102–2108CrossRefPubMedGoogle Scholar
  17. 17.
    Parrillo JE (1989) The cardiovascular pathophysiology of sepsis. Ann Rev Med 40: 469–485PubMedGoogle Scholar
  18. 18.
    Solomon SB, Minneci PC, Deans KJ, et al (2009) Effects of intra-aortic balloon counterpulsation in a model of septic shock. Crit Care Med 37: 7–18CrossRefPubMedGoogle Scholar
  19. 19.
    Müller-Werdan U, Buerke M, Ebelt H, et al (2006) Septic cardiomyopathy — A not yet discovered cardiomyopathy? Exp Clin Cardiol 11: 226–236PubMedGoogle Scholar
  20. 20.
    Werdan K, Oelke A, Müller-Werdan U (2009) “Myocardial Depression” or “Septic Cardiomyopathy”? In: Vincent JL (ed) 2009 Yearbook of Intensive Care and Emergency Medicine. Springer, Heidelberg, pp 183–194CrossRefGoogle Scholar
  21. 21.
    Pilz G, McGinn P, Boekstegers P, et al (1994) Pseudomonas sepsis does not cause more severe cardiovascular dysfunction in patients than Non-Pseudomonas sepsis. Circ Shock 42: 174–182PubMedGoogle Scholar
  22. 22.
    Werdan K (2009) Intra-aortic balloon counterpulsation in septic shock — really? Crit Care Med 37: 325–326CrossRefPubMedGoogle Scholar
  23. 23.
    Pribble CG, Shaddy RE (1991) Intra-aortic counterpulsation in newborn lambs infected with group B streptococcus. ASAIO Trans 37: 33–37CrossRefPubMedGoogle Scholar
  24. 24.
    Engoren M, Habib RH (2004) Effects of intraaortic augmentation in a porcine model of endotoxemic shock. Resuscitation 60: 319–326CrossRefPubMedGoogle Scholar
  25. 25.
    Berger RL, Saini VK, Long W, et al (1973) The use of diastolic augmentation with the intraaortic balloon in human septic shock with associated coronary artery disease. Surgery 74: 601–606PubMedGoogle Scholar
  26. 26.
    Foster ED, Subramanian VA, Vito L, et al (1975) Response to intra-aortic balloon pumping. Am J Surg 129: 464–471CrossRefPubMedGoogle Scholar
  27. 27.
    Mercer D, Doris O, Salerno TA (1981) Intra-aortic balloon counterpulsation in septic shock. Can J Surg 24: 643–645PubMedGoogle Scholar
  28. 28.
    Kohsaka S, Menon V, Lowe AM, et al (2005) Systemic inflammatory response syndrome after acute myocardial infarction complicated by cardiogenic shock. Arch Intern Med 165: 1643–1650CrossRefPubMedGoogle Scholar
  29. 29.
    Kohsaka S, Menon V, Iwato K, et al (2007) Microbiological profile of septic complications in patients with cardiogenic shock following acute myocardial infarction (from the SHOCK study). Am J Cardiol 99: 802–804CrossRefPubMedGoogle Scholar
  30. 30.
    Christoph A, Prondzinsky R, Russ M et al (2008) Early and sustained haemodynamic improvement with levosimendan compared with intraaortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction. Acute Card Care 10: 49–57CrossRefPubMedGoogle Scholar
  31. 31.
    Fincke R, Hochman JS, Lowe AM, et al (2004) Cardiac power is the strongest hemodynamic correlate of mortality in cardiogenic shock complicating myocardial infarction. J Am Coll Cardiol 44: 340–346CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2010

Authors and Affiliations

  • K. Werdan
    • 1
  • M. Russ
    • 1
  • M. Buerke
    • 1
  1. 1.Department of Medicine IIIUniversity HospitalHalleGermany

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