Bedside insertion of intra-aortic balloon pump feasible and safe without transfer to cath lab
Italy: A recent study in the journal Catheterization and Cardiovascular Interventions has found performing intra-aortic balloon pump (IABP) insertions in the cardiac intensive care unit (ICU) to be feasible without transferring patients to the catheterization laboratory. This could be of relevant interest in patients with acute decompensated heart failure (ADHF)-related cardiogenic shock (CS) who may not require coronary angiography or other urgent CathLab procedures.
In contemporary Cardiac Intensive Care Unit (CICU), bedsite insertion of an intra-aortic balloon pump under echocardiographic guidance may be an attractive option for selected patients with cardiogenic shock. However, not much data is currently available on this approach.
Considering the above, Luca Baldetti, Cardiac Intensive Care Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy, and colleagues aimed to assess the safety and feasibility of bedside IABP insertion versus fluoroscopic-guided insertion in the Catheterization Laboratory (CathLab). The researchers also described the clinical features of patients receiving bedside IABP insertion using a standardized technique in real-world CICU practice.
For this purpose, the researchers prospectively evaluated all patients admitted to the CICU who received transfemoral IABP between June 2020 and October 2021. The overall study cohort was divided in accordance with the implant strategy in the bedside and CathLab groups.
Correct radiographic IABP positioning at the first bedside chest X-ray obtained after insertion is the primary outcome. Secondary outcomes included IABP-related complications.
Following were the salient findings of the study:
· Among 115 patients, bedside IABP insertion was performed in 35 (30.4%) cases, mainly presenting with CS-related to acute decompensated heart failure (ADHF) (68.6 vs 33.8%), with lower LVEF, a higher proportion of right ventricular involvement and higher need of inotropes/vasopressors, compared to those receiving CathLab insertion.
· Bedside IABP insertion resulted in feasible and safe, with similar rates of correct IABP positioning (82.9 vs. 82.5%) and IABP-related major vascular complications (5.7 vs. 5.0%), as compared to CathLab positioning.
"These findings suggest the feasibility and safety of bedside IABP insertion, which could be of relevant interest in patients with ADHF-related CS who may not need coronary angiography or other urgent CathLab procedures," the authors wrote in their study.
Reference:
Baldetti L, Beneduce A, Boccellino A, Pagnesi M, Barone G, Gallone G, Napolano A, Gramegna M, Calvo F, Pazzanese V, Sacchi S, Cappelletti AM. Bedside intra-aortic balloon pump insertion in cardiac intensive care unit: A single-center experience. Catheter Cardiovasc Interv. 2022 Apr 14. doi: 10.1002/ccd.30197. Epub ahead of print. PMID: 35419933.
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