ABSTRACT
OBJECTIVES: This study presents clinical data from the first large registry of aortic counterpulsation, a computerized database that incorporates prospectively gathered data on indications for intra-aortic balloon counterpulsation (IABP) use, patient demographics, concomitant medication and in-hospital outcomes and complications. BACKGROUND: The intra-aortic balloon pump (IABP) is widely used to provide circulatory support for patients experiencing hemodynamic instability due to myocardial infarction, cardiogenic shock, or in very high risk patients undergoing angioplasty or coronary artery bypass grafting. METHODS: Between June 1996 and August 2000, 203 hospitals worldwide (90% U.S., 10% non-U.S.) collected 16,909 patient case records (68.8% men, 31.2% women; mean age 65.9 +/- 11.7 years). RESULTS: The most frequent indications for use of IABP were as follows: to provide hemodynamic support during or after cardiac catheterization (20.6%), cardiogenic shock (18.8%), weaning from cardiopulmonary bypass (16.1%), preoperative use in high risk patients (13.0%) and refractory unstable angina (12.3%). Major IABP complications (major limb ischemia, severe bleeding, balloon leak, death directly due to IABP insertion or failure) occurred in 2.6% of cases; in-hospital mortality was 21.2% (11.6% with the balloon in place). Female gender, high age and peripheral vascular disease were independent predictors of a serious complication. CONCLUSIONS: This registry provides a useful tool for monitoring the evolving practice of IABP. In the modern-day practice of IABP, complication rates are generally low, although in-hospital mortality remains high. There is an increased risk of major complications in women, older patients and patients with peripheral vascular disease.
Subject(s)
Benchmarking/organization & administration , Intra-Aortic Balloon Pumping/statistics & numerical data , Intra-Aortic Balloon Pumping/standards , Practice Patterns, Physicians'/standards , Registries , Age Factors , Aged , Angina, Unstable/therapy , Cardiac Catheterization , Cardiopulmonary Bypass , Coronary Artery Bypass , Data Collection/methods , Female , Guideline Adherence/standards , Guideline Adherence/statistics & numerical data , Hospital Mortality , Humans , Intra-Aortic Balloon Pumping/adverse effects , Intra-Aortic Balloon Pumping/mortality , Male , Middle Aged , Patient Selection , Practice Guidelines as Topic/standards , Practice Patterns, Physicians'/statistics & numerical data , Predictive Value of Tests , Prospective Studies , Risk Factors , Shock, Cardiogenic/therapy , Treatment OutcomeABSTRACT
This article provides a description of correct balloon pump timing as well as the potential timing errors that can occur. There are many factors in addition to timing that can affect the altered arterial waveform during balloon pumping. When analyzing the waveform for appropriate timing, it is important to consider factors associated with the patient, the IAB, and the IABP console. Patient treatment decisions should be based on the complete clinical picture, not solely on the characteristics of the altered arterial waveform.
