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Primary Intra-Aortic Balloon Pump (P IABP)

Primary intra aortic balloon pump

anwerghanijaber
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Primary Intra-Aortic Balloon Pump (P IABP)

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  1. Primary Intra-Aortic Balloon Pump (P IABP) ANWER GHANI FIBMS IRAQ

  2. Primary Intra-Aortic Balloon Pump (P IABP) means the use of IABP before inotropes for cardiogenic Shock (CS).

  3. The overall haemodynamic effects of IABP therapy

  4. IABP IN CS The overall hospital survival of patients with reported CS was 40.2%. (1)

  5. IABP IN CS Hospital survival rate of patients with (any) MCS is higher than in patients without (survival: any MCS = 44.8%; medical treatment = 39.5%). (1)

  6. IABP IN CS Survival of patients on MCS was significantly different between the devices (survival: IABP = 49.5%; pVAD = 36.2%; VA-ECMO = 30.5%. (1) (MCS) = mechanical circulatory support

  7. IABP IN CS Survival: IABP = 49.5%. (1) It should be borne in mind that IABP patients are more risky than inotropes patients. However, it achieves a higher rate of survival.

  8. IABP IN CS Highest overall survival was detected in patients with IABP in comparison to other MCS. (1)

  9. IABP IN CS The hospital survival rates of patients with IABP were significantly higher than for patients with other MCS or for patients with medical therapy. (1)

  10. IABP IN NICSNICS= Non ischemic CS ∆SvO2 was higher in the IABP group compared to intopes (+17 vs. +5 ). (2) (SvO2)= mixed-venous oxygen saturation to assess organ perfusion.

  11. IABP IN NICS IABP patients had a higher ∆CPO in comparison to Inotropes patients. (2) (CPO) =cardiac power output

  12. IABP IN NICS IABP patients had a a greater relative reduction in NT-proBNP in comparison to Inotropes patients. (2)

  13. IABP IN NICS IABP patients had a more negative cumulative fluid balancein comparison to Inotropes patients. (2)

  14. IABP IN NICS IABP patients had a greater reduction in dyspnoea severity score.in comparison to Inotropes patients. (2)

  15. IABP IN NICS There were no IABP-related serious adverse events (SAEs). (2)

  16. IABP IN NICS Thirty-day mortality was 23% (IABP) vs. 44% (INO). (2) THIS IS SO IMPORTANT

  17. IABP IN ICSICS = Ischemic CS The predominant benefit of IABP on high-risk patients with severe coronary stenosis may relate to a reduction in oxygen demand through LV systolic unloading over and above that stimulated by diastolic augmentation of the coronary blood flow. (3)

  18. IABP IN ICS By decreasing LV end-diastolic pressure following an unloading of the LV, IABP decreases the LV wall tension and LV transmural pressure. (3)

  19. IABP IN ICS Few studies are available concerning the use of IABP compared to standard of care (noradrenalin, dobutamine, and intensive care unit management) or Impella mechanical support device.(3)

  20. IABP IN ICS

  21. IABP IN ICS Cardiogenic shock complicating myocardial infarction: in the thrombolytic era, IABP was mainly implanted in patients with haemodynamic instability or CS with overall favourable results in registries or small randomized trials. (4)

  22. IABP IN ICS IABP wide use has been in part related to the Class I recommendation set in the previous European and American guidelines, despite a level of evidence of C and B respectively due to the small sample size of the supporting studies (mostly observational). (4) Today, IABP usage has a class IIb recommendation in the American guidelines and a class III recommendation in the European guidelines according to IABP SHOCK II study and others.

  23. IABP IN ICS IABP-SHOCK II is currently the largest available randomized clinical trial investigating the role of IABP in patients with AMI and CS, and the authors should be commended for their efforts. However, several study limitations are evident. (4)

  24. IABP IN ICS However, all the aforementioned studies were not adequately powered either to investigate an association between IABP and mortality as a single Endpoint or to draw definite conclusions. (4)

  25. IABP IN ICS The neutral results of the IABP-SHOCK II trial might be related to a late IABP implantation, which occurred in the vast majority of cases after PCI. (4) Today, IABP usage has a class IIb recommendation in the American guidelines and a class III recommendation in the European guidelines according this study and others.

  26. IABP IN ICS The insertion of IABP before PCI was associated with a significant reduction in mortality and adverse cardiovascular events. (4)

  27. IABP IN ICS Recently, a study including patients with CS due to different aetiologies, confirmed that an early placement of IABP was an independent predictor of 30 days survival. (4)

  28. IABP IN ICS In a subgroup analysis of the CRISP-AMI trial in patients with large anterior STEMI and persisting ischaemia after PCI, the use of IABP was associated with a significant mortality reduction at 6 months. (4)

  29. IABP IN ICS In Hawranek et al. (7200 patients with AMI complicated by CS) Patients treated with IABP presented lower systolic arterial pressure and LVEF, higher heart rate, rate of multivessel coronary artery disease, and involvement of left main and left anterior descending artery. The use of IABP was associated with higher 30-day and 1-year mortality, recurrent MI, stroke, recurrent PCI, major bleeding, and cardiac arrest, due to the higher risk profile of patients treated with the device. However, in patients with final TIMI flow 0/1, IABP use was an independent predictor of lower 30-days mortality .

  30. IABP IN ICS The use of IABP should be considered in the very early phases of CS and in patients with impending shock. (4)

  31. IABP IN ICS Therefore, it is crucial to timely identify patients who are at risk of developing CS (or in CS initial phase) searching for early signs of CS such as initial increase in lactate levels in a setting of organ hypoperfusion. (4)

  32. IABP IN ICS It seems reasonable to proceed with IABP implantation in patients with impending shock/CS, provided it is implanted in the very early phases of heart failure/CS. (4)

  33. Conclusions We need: 1- more and big studies about IABP. 2- more targets other than mortality. 2- Early IABP use. IABP looks more useful than we think.

  34. Reference 1-Corinna N. Lang et al; Cardiogenic shock: incidence, survival and mechanical circulatory support usage 2007–2017-insights from a national registry. Clin Res Cardiol. 2021; 110(9): 1421–1430. 2- Corstiaan A den Uil 1et al; Primary intra-aortic balloon support versus inotropes for decompensated heart failure and low output: a randomised trial.- EuroIntervention 2019 Sep 20;15(7):586-593. 3-Florian Rey et al; Intra-Aortic Balloon Pump and Ischemic Cardiogenic Shock May Still Be a Valuable Association. J Clin Med. 2021 Feb; 10(4): 778. 4- Roberta Rossini ET AL; ANMCO POSITION PAPER: Role of intra-aortic balloon pump in patients with acute advanced heart failure and cardiogenic shock.Eur Heart J Suppl. 2021 Aug.

  35. THANKS

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