Australasian trends in intra-aortic balloon counterpulsation weaning: results of a postal survey.
OBJECTIVE
To generate baseline data describing Australasian intra-aortic balloon counterpulsation (IABP) weaning practice.


METHODS
A five-part questionnaire was mailed in April 2005 to all 192 intensive care units in Australia and New Zealand.


RESULTS
116 ICUs responded (response rate, 60%), and 54 reported using IABP. Most of the 54 were in hospitals which were public government-funded (65%), had between 100 and 500 beds (69%), and treated a minimum of 11 patients annually with IABP (60%). The most common method of withdrawing IABP support was ratio reduction alone (61%). ICUs most likely to undertake ratio weaning were higherend users of IABP (> 20 cases per annum) (P = 0.04). Other weaning practices involved a combination of ratio followed by volume reduction (17%), volume then ratio (11%), and volume only (4%). Approaching statistical significance, ratio reduction weaning less frequently required IABP reinsertion or inotropic increase after balloon removal (P = 0.07). ICUs with documented weaning policies were less likely to require IABP reinsertion or inotropic increase after balloon removal (P = 0.06). Criteria considered important before IABP weaning or removal were: blood pressure (92%); heart rate (76%); pulmonary artery wedge pressure (59%); noradrenaline dose (78%); adrenaline dose (57%); and dobutamine dose (57%). Ninety per cent of ICUs reported increasing inotropes after balloon removal only rarely (1:50 patients) or occasionally (1:10 patients), while 87% of ICUs reported never needing to reinsert the balloon or only rarely.


CONCLUSIONS
The Australasian approach to IABP weaning is eclectic. While ratio reduction weaning appears the most successful manner of support withdrawal, it may be a consequence of a volume-outcome relationship, with high- end users achieving better results through IABP familiarity.
Lewis
Peter A
PA
Christchurch Polytechnic Institute of Technology, Christchurch, New Zealand.
Mullany
Daniel V
DV
Courtney
Mary
M
Coyer
Fiona
F
D001315:Australia; D001794:Blood Pressure / Q000502:physiology; D003625:Data Collection; D004280:Dobutamine / Q000008:administration & dosage; D004837:Epinephrine / Q000008:administration & dosage; D006339:Heart Rate / Q000502:physiology; D006801:Humans; D007362:Intensive Care Units; D007423:Intra-Aortic Balloon Pumping / Q000706:statistics & numerical data*; D009200:Myocardial Contraction / Q000502:physiology; D009520:New Zealand; D009638:Norepinephrine / Q000008:administration & dosage; D011669:Pulmonary Wedge Pressure / Q000502:physiology; D011795:Surveys and Questionnaires
D004280:Dobutamine; D009638:Norepinephrine; D004837:Epinephrine