Intra-aortic balloon counterpulsation in the emergency department: a 7-year review and analysis of predictors of survival.
BACKGROUND
Intra-aortic balloon pump (IABP) counterpulsation in cardiogenic shock (CS) is suggested as bridging therapy to definite emergency revascularization, heart transplantation and acute valvular repair. Data concerning the use of IABP counterpulsation in an emergency department (ED) are rare.


METHODS
We reviewed retrospectively the charts of patients who had been treated by IABP counterpulsation in the ED of a tertiary care university hospital during a 7-year period. We analyzed indications for IABP treatment, complications of IABP use and studied various predictors for 30-day survival.


RESULTS
Overall 88 (68 male) patients, median age 60 years (IQR 53-69 years) were treated with IABP counterpulsation. CS was caused by acute coronary syndrome (ACS), acute cardiomyopathy decompensation of (CMP) and aortic stenosis (AS) in 77 (87%), ten (12%) and one (1%) patients, respectively. Complications attributed to the insertion or maintenance of IABP were observed in nine (10%) patients. Thirty four patients (38%; 24 male) survived. Compared to non-survivors, these patients were younger (56 vs. 63 years; P<0.023) and had significant lower serum lactate levels before IABP insertion (3 vs. 5.5 mmol/l; P<0.002). Logistic regression analysis identified age (P<0.04) and serum lactate serum level before IABP (P<0.01) as independent predictors for survival. In the 77 patients with ACS PTCA tended to be associated with a higher rate of survival (P<0.09).


CONCLUSIONS
Initiation of IABP counterpulsation in patients with CS in an ED appears safe. Low levels of serum lactate and younger age were independent predictors of survival. In patients with ACS PTCA may contribute to improved outcome.
Bur
Andreas
A
Department of Emergency Medicine, Allgemeines Krankenhaus der Stadt Wien, Währinger Gürtel 18-20, 1090 Vienna, Austria.
Bayegan
Keywan
K
Holzer
Michael
M
Herkner
Harald
H
Schreiber
Wolfgang
W
Siostrzonek
Peter
P
Hirschl
Michael M
MM
Laggner
Anton N
AN
Domanovits
Hans
H
D000140:Acidosis, Lactic / Q000097:blood; D000208:Acute Disease; D000368:Aged; D001024:Aortic Valve Stenosis / Q000150:complications; D009202:Cardiomyopathies / Q000150:complications; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000401:mortality; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors