The intra-aortic balloon pump: a modern practical perspective

PURPOSE OF REVIEW: After more than 50 years from its invention, the intra-aortic balloon pump (IABP) is still one of the most widely used mechanical circulatory support devices to treat cardiogenic shock (CS). This review aims to describe the role of IABP in current clinical practice. RECENT FINDINGS: In recent years the better understanding of the variable hemodynamic profiles that characterize the CS condition has led to a reappraisal of the IABP role in select CS phenotypes. Combining a "mechanical" afterload reduction with an increase in mean arterial pressure, this device appears particularly suited to treat acute decompensated heart failure-CS and the mechanical complications of an acute myocardial infarction, as these conditions would greatly benefit from systemic afterload reduction. Notwithstanding the negative results of IABP support for acute myocardial infarction-related CS, this document reviews other potential established and emerging settings of application. SUMMARY: In this scoping review, we discuss the IABP design and hemodynamic effects, with a pathophysiology-oriented outlook to its clinical use. Different options for IABP device insertion, potential complications, and optimal device synchronization with cardiac cycle are also summarized with the aim to provide an updated, pragmatic guide to critical care physicians using these devices.