Intra-aortic Balloon Pump Combined with Mechanical Ventilation for Treating Patients Aged > 60 Years in Cardiogenic Shock: Retrospective Analysis

Overview

Journal J Int Med Res

Publisher Sage Publications

Specialty General Medicine

Date 2016 Mar 30

PMID 27020597

Citations 2

Authors

Hongwei Liu

Xueping Wu

Xiaoning Zhao

Ping Zhu

Lina Han

Affiliations

Soon will be listed here.

Abstract

Objective: To examine if mechanical ventilation with positive end-expiratory pressure (PEEP) combined with intra-aortic balloon pump (IABP) provided a better outcome than IABP alone for the treatment of cardiogenic shock after acute myocardial infarction in patients aged > 60 years.

Methods: This was a retrospective analysis of data from patients in cardiogenic shock, refractory to pharmacological therapy and treated at a geriatric coronary care unit.

Results: Sixty-two patients were eligible for study inclusion: 33 received IABP alone; 29 received IABP combined with mechanical ventilation. Patients in the IABP + mechanical ventilation group had lower mean arterial blood pressure (BP), systolic BP and partial pressure of oxygen compared with the IABP group, indicating worse cardiac and pulmonary function. In addition, higher rates of pulmonary infection and renal insufficiency were observed in the IABP + mechanical ventilation group than in the IABP group. A statistically significant improvement of left ventricular function before and after treatment was observed in the IABP + mechanical ventilation group, but not in the IABP group. Pulmonary infection and renal insufficiency were risk factors for all-cause in-hospital mortality; successful revascularization was a negative risk factor. There was no between-group difference in survival.

Conclusion: Mechanical ventilation with an appropriate level of PEEP appears to enhance the beneficial effects of IABP on left ventricular function for patients in cardiogenic shock.

Citing Articles

Ventilation strategies in cardiogenic shock: Insights from the AltShock-2 registry.

Sacco A, Montisci A, Tavecchia G, Frea S, Bernasconi D, Colombo C Eur J Heart Fail. 2024; 26(11):2412-2420.

PMID: 39105476 PMC: 11659490. DOI: 10.1002/ejhf.3409.

Percutaneous coronary intervention assisted by invasive mechanical ventilation and intra-aortic balloon pump for acute myocardial infarction with cardiogenic shock: Retrospective cohort study and meta-analyses.

Liu Y, Li C, Lu P, Wang X, Xiao J, Gao M Bosn J Basic Med Sci. 2019; 20(4):514-523.

PMID: 31782697 PMC: 7664793. DOI: 10.17305/bjbms.2019.4500.

References

Dongelmans D, Hemmes S, Kudoga A, Veelo D, Binnekade J, Schultz M . Positive end-expiratory pressure following coronary artery bypass grafting. Minerva Anestesiol. 2012; 78(7):790-800. View

Hochman J, Sleeper L, WEBB J, Sanborn T, White H, Talley J . Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. N Engl J Med. 1999; 341(9):625-34. DOI: 10.1056/NEJM199908263410901. View

Masip J . Noninvasive ventilation in acute cardiogenic pulmonary edema. Curr Opin Crit Care. 2008; 14(5):531-5. DOI: 10.1097/MCC.0b013e32830c4862. View

Thiele H, Schuler G, Neumann F, Hausleiter J, Olbrich H, Schwarz B . Intraaortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock: design and rationale of the Intraaortic Balloon Pump in Cardiogenic Shock II (IABP-SHOCK II) trial. Am Heart J. 2012; 163(6):938-45. DOI: 10.1016/j.ahj.2012.03.012. View

Goldberg R, Spencer F, Gore J, Lessard D, Yarzebski J . Thirty-year trends (1975 to 2005) in the magnitude of, management of, and hospital death rates associated with cardiogenic shock in patients with acute myocardial infarction: a population-based perspective. Circulation. 2009; 119(9):1211-9. PMC: 2730832. DOI: 10.1161/CIRCULATIONAHA.108.814947. View

Kontoyannis D, Nanas J, Kontoyannis S, Stamatelopoulos S, Moulopoulos S . Mechanical ventilation in conjunction with the intra-aortic balloon pump improves the outcome of patients in profound cardiogenic shock. Intensive Care Med. 1999; 25(8):835-8. DOI: 10.1007/s001340050960. View

Bahekar A, Singh M, Singh S, Bhuriya R, Ahmad K, Khosla S . Cardiovascular outcomes using intra-aortic balloon pump in high-risk acute myocardial infarction with or without cardiogenic shock: a meta-analysis. J Cardiovasc Pharmacol Ther. 2011; 17(1):44-56. DOI: 10.1177/1074248410395019. View

Thiele H, Zeymer U, Neumann F, Ferenc M, Olbrich H, Hausleiter J . Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet. 2013; 382(9905):1638-45. DOI: 10.1016/S0140-6736(13)61783-3. View

Naughton M, Rahman M, Hara K, Floras J, Bradley T . Effect of continuous positive airway pressure on intrathoracic and left ventricular transmural pressures in patients with congestive heart failure. Circulation. 1995; 91(6):1725-31. DOI: 10.1161/01.cir.91.6.1725. View

10.

Zickman B, Sablotzki A, Fussle R, Gorlach G, Hempelmann G . Perioperative microbiologic monitoring of tracheal aspirates as a predictor of pulmonary complications after cardiac operations. J Thorac Cardiovasc Surg. 1996; 111(6):1213-8. DOI: 10.1016/s0022-5223(96)70224-6. View

11.

Kern M, Aguirre F, Bach R, Donohue T, Siegel R, Segal J . Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation. 1993; 87(2):500-11. DOI: 10.1161/01.cir.87.2.500. View

12.

Stenberg T, Kildal A, Sanden E, How O, Hagve M, Ytrehus K . The acute phase of experimental cardiogenic shock is counteracted by microcirculatory and mitochondrial adaptations. PLoS One. 2014; 9(9):e105213. PMC: 4154851. DOI: 10.1371/journal.pone.0105213. View

13.

Cook D, Walter S, Cook R, Griffith L, Guyatt G, Leasa D . Incidence of and risk factors for ventilator-associated pneumonia in critically ill patients. Ann Intern Med. 1998; 129(6):433-40. DOI: 10.7326/0003-4819-129-6-199809150-00002. View

14.

Wiesen J, Ornstein M, Tonelli A, Menon V, Ashton R . State of the evidence: mechanical ventilation with PEEP in patients with cardiogenic shock. Heart. 2013; 99(24):1812-7. PMC: 4096289. DOI: 10.1136/heartjnl-2013-303642. View

15.

Thiele H, Zeymer U, Neumann F, Ferenc M, Olbrich H, Hausleiter J . Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med. 2012; 367(14):1287-96. DOI: 10.1056/NEJMoa1208410. View

16.

Fuernau G, Thiele H . Intra-Aortic Balloon Pump (IABP) in cardiogenic shock. Curr Opin Crit Care. 2013; 19(5):404-9. DOI: 10.1097/MCC.0b013e328364d78d. View

17.

Alexander J, Reynolds H, Stebbins A, Dzavik V, Harrington R, Van de Werf F . Effect of tilarginine acetate in patients with acute myocardial infarction and cardiogenic shock: the TRIUMPH randomized controlled trial. JAMA. 2007; 297(15):1657-66. DOI: 10.1001/jama.297.15.joc70035. View

18.

Malbouisson L, Brito M, Carmona M, Auler J . Hemodynamic impact of alveolar recruitment maneuver in patients evolving with cardiogenic shock in the immediate postoperative period of myocardial revascularization. Rev Bras Anestesiol. 2009; 58(2):112-23. DOI: 10.1590/s0034-70942008000200004. View

19.

Awad H, Anderson Jr F, Gore J, Goodman S, Goldberg R . Cardiogenic shock complicating acute coronary syndromes: insights from the Global Registry of Acute Coronary Events. Am Heart J. 2012; 163(6):963-71. DOI: 10.1016/j.ahj.2012.03.003. View

20.

Champion S . The double-edged sword of mechanical ventilation for patients with cardiogenic shock. Cardiol J. 2014; 21(4):449. DOI: 10.5603/CJ.2014.0054. View