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Fang D, Yu D, Xu J, Ma W, Zhong Y, Chen H. Effects of intra-aortic balloon pump on in-hospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock. BMC Cardiovasc Disord 2023; 23:425. [PMID: 37644466 PMCID: PMC10466728 DOI: 10.1186/s12872-023-03465-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 08/22/2023] [Indexed: 08/31/2023] Open
Abstract
BACKGROUND The role of intra-aortic balloon counterpulsation (IABP) in cardiogenic shock complicating acute myocardial infarction (AMI) is still a subject of intense debate. In this study, we aim to investigate the effect of IABP on the clinical outcomes of patients with AMI complicated by cardiogenic shock undergoing percutaneous coronary intervention (PCI). METHODS From the Medical Information Mart for Intensive Care (MIMIC)-IV 2.2, 6017 AMI patients were subtracted, and 250 patients with AMI complicated by cardiogenic shock undergoing PCI were analyzed. In-hospital outcomes (death, 24-hour urine volumes, length of ICU stays, and length of hospital stays) and 1-year mortality were compared between IABP and control during the hospital course and 12-month follow-up. RESULTS An IABP was implanted in 30.8% (77/250) of patients with infarct-related cardiogenic shock undergoing PCI. IABP patients had higher levels of Troponin T (3.94 [0.73-11.85] ng/ml vs. 1.99 [0.55-5.75] ng/ml, p-value = 0.02). IABP patients have a longer length of ICU and hospital stays (124 [63-212] hours vs. 83 [43-163] hours, p-value = 0.005; 250 [128-435] hours vs. 170 [86-294] hours, p-value = 0.009). IABP use was not associated with lower in-hospital mortality (33.8% vs. 33.0%, p-value = 0.90) and increased 24-hour urine volumes (2100 [1455-3208] ml vs. 1915 [1110-2815] ml, p-value = 0.25). In addition, 1-year mortality was not different between the IABP and the control group (48.1% vs. 48.0%; hazard ratio 1.04, 95% CI 0.70-1.54, p-value = 0.851). CONCLUSION IABP may be associated with longer ICU and hospital stays but not better short-and long-term clinical prognosis.
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Affiliation(s)
- Dingfeng Fang
- Shenzhen University Health Science Center, Shenzhen, 518060, China
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Dongdong Yu
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Jiabin Xu
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Wei Ma
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Yuxiang Zhong
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China
| | - Haibo Chen
- Department of Cardiology, Shenzhen Second People's Hospital, No. 3002, Sungang West Road, Futian District, Shenzhen, 518035, China.
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2
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Simko LC. Cardiogenic Shock and the Use of Percutaneous Mechanical Assist Devices. Crit Care Nurse 2022; 42:56-67. [PMID: 35100629 DOI: 10.4037/ccn2022140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Percutaneous mechanical assist devices are used in patients with cardiogenic shock. The purpose of this article is to familiarize critical care nurses with the various types of percutaneous mechanical assist devices, including the intra-aortic balloon pump, the Impella device, extracorporeal membrane oxygenation, and the TandemHeart device. Each type of device requires specific nursing care. In a patient with cardiogenic shock, the monitoring, care, and interventions provided by an experienced critical care nurse can make the difference between survival and death.
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Affiliation(s)
- Lynn Coletta Simko
- Lynn Coletta Simko is a retired associate professor, North Versailles, Pennsylvania
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Yuan S, He J, Cai Z, Zhang R, Song C, Qiao Z, Song W, Feng L, Dou K. Intra-aortic balloon pump in cardiogenic shock: A propensity score matching analysis. Catheter Cardiovasc Interv 2022; 99 Suppl 1:1456-1464. [PMID: 35077594 DOI: 10.1002/ccd.30102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/13/2022] [Accepted: 01/13/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To assess the impact of intra-aortic balloon pumps (IABP) on patients with cardiogenic shock in an intensive care unit setting. BACKGROUND IABP counterpulsation is a widely used mechanical circulatory support device, but its performance has been questioned. However, current evidence of IABP use in cardiogenic shock is very limited (mainly from the IABP-SHOCK II trial), which was restricted to cardiogenic shock complicating acute myocardial infarction. METHODS This was a retrospective, real-world, cohort study based on the Medical Information Mart for Intensive Care III database. Adult patients with a diagnosis of cardiogenic shock were eligible. RESULTS A total of 1028 patients with cardiogenic shock were assessed, including 384 patients who received IABP and 644 patients who did not. The in-hospital mortality was significantly lower in patients who received IABP (adjusted odds ratio: 0.75, 95% confidence interval: 0.62-0.91, p = 0.009). Analysis of secondary endpoints found that the use of IABP was associated with a significantly lower risk of 1-year mortality. After propensity score matching, the in-hospital mortality remained significantly lower in the IABP group (28.10% vs. 37.59%, p = 0.018). CONCLUSIONS In the current cohort, IABP treatment was associated with a lower risk of in-hospital mortality in patients with cardiogenic shock. Due to the complexity of pathophysiology in cardiogenic shock and the discrepancies in current evidence, our results should be validated through further studies in the future.
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Affiliation(s)
- Sheng Yuan
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiometabolic Medicine, Cardiometabolic Medicine Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Jining He
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiometabolic Medicine, Cardiometabolic Medicine Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zhongxing Cai
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiometabolic Medicine, Cardiometabolic Medicine Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Rui Zhang
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiometabolic Medicine, Cardiometabolic Medicine Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Chenxi Song
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiometabolic Medicine, Cardiometabolic Medicine Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Zheng Qiao
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiometabolic Medicine, Cardiometabolic Medicine Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Weihua Song
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiology, Coronary Heart Disease Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Lei Feng
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiology, Coronary Heart Disease Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
| | - Kefei Dou
- State Key Laboratory of Cardiovascular Disease, Beijing, China.,Department of Cardiometabolic Medicine, Cardiometabolic Medicine Center, National Center for Cardiovascular Diseases, Fu Wai Hospital, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China
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Reymond P, Bendjelid K, Giraud R, Richard G, Murith N, Cikirikcioglu M, Huber C. To Balloon or Not to Balloon? The Effects of an Intra-Aortic Balloon-Pump on Coronary Artery Flow during Extracorporeal Circulation Simulating Normal and Low Cardiac Output Syndromes. J Clin Med 2021; 10:jcm10225333. [PMID: 34830619 PMCID: PMC8624867 DOI: 10.3390/jcm10225333] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 11/10/2021] [Accepted: 11/11/2021] [Indexed: 11/30/2022] Open
Abstract
ECMO is the most frequently used mechanical support for patients suffering from low cardiac output syndrome. Combining IABP with ECMO is believed to increase coronary artery blood flow, decrease high afterload, and restore systemic pulsatile flow conditions. This study evaluates that combined effect on coronary artery flow during various load conditions using an in vitro circuit. In doing so, different clinical scenarios were simulated, such as normal cardiac output and moderate-to-severe heart failure. In the heart failure scenarios, we used peripheral ECMO support to compensate for the lowered cardiac output value and reach a default normal value. The increase in coronary blood flow using the combined IABP-ECMO setup was more noticeable in low heart rate conditions. At baseline, intermediate and severe LV failure levels, adding IABP increased coronary mean flow by 16%, 7.5%, and 3.4% (HR 60 bpm) and by 6%, 4.5%, and 2.5% (HR 100 bpm) respectively. Based on our in vitro study results, combining ECMO and IABP in a heart failure setup further improves coronary blood flow. This effect was more pronounced at a lower heart rate and decreased with heart failure, which might positively impact recovery from cardiac failure.
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Affiliation(s)
- Philippe Reymond
- Charles Hahn Hemodynamic Propulsion Laboratory, Medical Faculty, University of Geneva, 1211 Geneva, Switzerland; (G.R.); (N.M.); (M.C.)
- Division of Cardiovascular Surgery, Department of Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland
- Correspondence: (P.R.); (C.H.)
| | - Karim Bendjelid
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva Hemodynamic Research Group, University Hospitals and Medical Faculty of Geneva, 1211 Geneva, Switzerland; (K.B.); (R.G.)
| | - Raphaël Giraud
- Department of Anesthesiology, Pharmacology and Intensive Care, Geneva Hemodynamic Research Group, University Hospitals and Medical Faculty of Geneva, 1211 Geneva, Switzerland; (K.B.); (R.G.)
| | - Gérald Richard
- Charles Hahn Hemodynamic Propulsion Laboratory, Medical Faculty, University of Geneva, 1211 Geneva, Switzerland; (G.R.); (N.M.); (M.C.)
- Division of Cardiovascular Surgery, Department of Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland
| | - Nicolas Murith
- Charles Hahn Hemodynamic Propulsion Laboratory, Medical Faculty, University of Geneva, 1211 Geneva, Switzerland; (G.R.); (N.M.); (M.C.)
- Division of Cardiovascular Surgery, Department of Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland
| | - Mustafa Cikirikcioglu
- Charles Hahn Hemodynamic Propulsion Laboratory, Medical Faculty, University of Geneva, 1211 Geneva, Switzerland; (G.R.); (N.M.); (M.C.)
- Division of Cardiovascular Surgery, Department of Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland
| | - Christoph Huber
- Charles Hahn Hemodynamic Propulsion Laboratory, Medical Faculty, University of Geneva, 1211 Geneva, Switzerland; (G.R.); (N.M.); (M.C.)
- Division of Cardiovascular Surgery, Department of Surgery, University Hospitals of Geneva, 1211 Geneva, Switzerland
- Correspondence: (P.R.); (C.H.)
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Benenati S, Toma M, Canale C, Vergallo R, Bona RD, Ricci D, Canepa M, Crimi G, Santini F, Ameri P, Porto I. Mechanical circulatory support in patients with cardiogenic shock not secondary to cardiotomy: a network meta-analysis. Heart Fail Rev 2021; 27:927-934. [PMID: 33677732 PMCID: PMC9033692 DOI: 10.1007/s10741-021-10092-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2021] [Indexed: 12/03/2022]
Abstract
To compare the efficacy and safety of different mechanical circulatory support (MCS) devices in CS. A total of 24 studies (7 randomized controlled trials—RCTs—and 17 non-RCTs) involving 11,117 patients were entered in a Bayesian network meta-analysis. The primary endpoint was 30-day mortality. Secondary endpoints were stroke and bleeding (requiring transfusion and/or intracranial and/or fatal). Compared with no MCS, extra-corporeal membrane oxygenation (ECMO) reduced 30-day mortality when used both alone (OR 0.37, 95% CrI 0.15–0.90) and together with the micro-axial pump Impella (OR 0.13, 95% CrI 0.02–0.80) or intra-aortic balloon pump (IABP) (OR 0.19, 95% CrI 0.05–0.63), although the relevant articles were affected by significant publication bias. Consistent results were obtained in a sensitivity analysis including only studies of CS due to myocardial infarction. After halving the weight of studies with a non-RCT design, only the benefit of ECMO + IABP on 30-day mortality was maintained (OR 0.22, 95% CI 0.057–0.76). The risk of bleeding was increased by TandemHeart (OR 13, 95% CrI 3.50–59), Impella (OR 5, 95% CrI 1.60–18), and IABP (OR 2.2, 95% CrI 1.10–4.4). No significant differences were found across MCS strategies regarding stroke. Although limited by important quality issues, the studies performed so far indicate that ECMO, especially if combined with Impella or IABP, reduces short-term mortality in CS. MCS increases the hazard of bleeding.
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Affiliation(s)
- Stefano Benenati
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Matteo Toma
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Claudia Canale
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Rocco Vergallo
- Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy
| | - Roberta Della Bona
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
| | - Davide Ricci
- Cardiac Surgery Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy
| | - Marco Canepa
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Gabriele Crimi
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
| | - Francesco Santini
- Cardiac Surgery Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy
| | - Pietro Ameri
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy.
- Department of Internal Medicine, University of Genoa, Genova, Italy.
| | - Italo Porto
- Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy
- Department of Internal Medicine, University of Genoa, Genova, Italy
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Knippa S. Blood Pressure Monitoring During Intra-Aortic Balloon Pumping. Crit Care Nurse 2019; 39:99-101. [PMID: 30936134 DOI: 10.4037/ccn2019675] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Affiliation(s)
- Sara Knippa
- Sara Knippa is a clinical nurse specialist and educator in the cardiac intensive care unit at the University of Colorado Hospital, Aurora, Colorado
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García Martínez JJ, Bendjelid K. Artificial liver support systems: what is new over the last decade? Ann Intensive Care 2018; 8:109. [PMID: 30443736 PMCID: PMC6238018 DOI: 10.1186/s13613-018-0453-z] [Citation(s) in RCA: 79] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Accepted: 11/07/2018] [Indexed: 12/16/2022] Open
Abstract
The liver is a complex organ that performs vital functions of synthesis, heat production, detoxification and regulation; its failure carries a highly critical risk. At the end of the last century, some artificial liver devices began to develop with the aim of being used as supportive therapy until liver transplantation (bridge-to-transplant) or liver regeneration (bridge-to-recovery). The well-recognized devices are the Molecular Adsorbent Recirculating System™ (MARS™), the Single-Pass Albumin Dialysis system and the Fractionated Plasma Separation and Adsorption system (Prometheus™). In the following years, experimental works and early clinical applications were reported, and to date, many thousands of patients have already been treated with these devices. The ability of artificial liver support systems to replace the liver detoxification function, at least partially, has been proven, and the correction of various biochemical parameters has been demonstrated. However, the complex tasks of regulation and synthesis must be addressed through the use of bioartificial systems, which still face several developmental problems and very high production costs. Moreover, clinical data on improved survival are conflicting. This paper reviews the progress achieved and new data published on artificial liver support systems over the past decade and the prospects for these devices.
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Affiliation(s)
- Juan José García Martínez
- Intensive Care Unit, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland. .,Faculty of Medicine, University of Geneva, Geneva, Switzerland.
| | - Karim Bendjelid
- Intensive Care Unit, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, 1205, Geneva, Switzerland.,Faculty of Medicine, University of Geneva, Geneva, Switzerland.,Geneva Hemodynamic Research Group, Geneva, Switzerland
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