The Early Benefit of Intra-Aortic Balloon Counterpulsation in Patients with Limited Pulse Pressure during Extracorporeal Life Support for Post-Cardiotomy Cardiogenic Shock

Objectives: Hemodynamically unstable cardiosurgical patients supported by an extracorporeal life support (ECLS) circuit empirically often receive additional intra-aortic balloon counterpulsation (IABP). This study aims to evaluate the effect of IABP on early outcome of ECLS for post-cardiotomy cardiogenic shock (PCS). Methods: We evaluated 226 patients (aged 60 ± 8 years) who received ECLS for PCS from January 2006 to August 2014. Of those, 58 patients underwent concomitant IABP support (IABP-group). The remaining 168 patients received ECLS only and served as a control group. Patient demographics, clinical characteristics, ECLS/IABP-related morbidity, as well as in-hospital mortality were analyzed. Results: Demographic data were comparable between the two groups with a mean age of 58 ± 8 (IABP-group) and 60 ± 5 years (control-group, p: 0.244), respectively. The incidence of intestinal malperfusion (IABP-group:7% versus control-group:6%, p: 0,251) and limb ischemia (IABP-group:16% versus control-group:14%, p: 0,172) was similar between the to groups. Overall, there was no significant difference regarding successful ECLS-weaning (IABP-group:52% versus control-group:44%, p: 0,131) and in-hospital mortality (IABP-group:67% versus control-group:75%, p: 0,083) between the IABP and control-group. Looking specifically at patients with a loss of endogenic pulse pressure (≤ 15 mm Hg) during ECLS-support (IABP-group, n = 21 and control-group, n = 47), concomitant IABP-triggered increase in pulse pressure demonstrated an improved incidence of successful ECLS-weaning (IABP-group: 58% versus control-group 23%, p:0.05). Yet, this benefit did not translate into an improved survival (IABP-group:65% versus control-group 67%, p:0.163). Conclusion: IABP during ECLS was not associated with an increased morbidity. Current data suggest a higher success rate of ECLS weaning with IABP in patients with insufficient pulse pressure. Larger multicenter studies may verify the impact of IABP during ECLS on survival in this particular patient cohort.