Benefits of the preemptive intra-aortic balloon pump: an audit of practice in a regional cardiothoracic center.
BACKGROUND
Recent evidence suggests that preemptive use of an intra-aortic balloon pump (IABP) is associated with better outcomes in high-risk patients undergoing cardiac surgery. This retrospective study compares preemptive (planned) use of the IABP to emergency (unplanned) use in a regional cardiothoracic center.


METHODS
All patients who required an IABP from February 2003 to June 2006 were identified from theater records. The collected data included patient demographics, preoperative state, operative details, morbidity due to the IABP, and operative mortality. Patients were divided into 2 groups: planned use (preoperative plus elective intraoperative) and unplanned use (postoperative plus emergency intraoperative). Preoperative mortality risk was calculated with the logistic EuroSCORE.


RESULTS
We identified 135 patients (75% male). There were no significant differences between the groups with respect to age, preoperative state, operation type, logistic EuroSCORE, or myocardial ischemia time. The 2 groups showed a significant difference in mortality: planned IABP insertion, 17%; unplanned insertion, 45% (P = .001). A multivariate analysis of the study population showed the logistic EuroSCORE (odds ratio, 0.974; 95% confidence interval, 0.950-0.998; P = .035) and timing of IABP use (odds ratio, 4.728; 95% confidence interval, 1.932-11.566; P = .001) to be independent predictors of mortality.


CONCLUSIONS
Preemptive use of the IABP in this patient cohort was associated with a 50% advantage in mortality compared with emergency IABP use. The logistic EuroSCORE may be used preoperatively to guide IABP use. Complications are rare and can be treated successfully. The risk-to-benefit ratio of preemptive IABP use is low in this cohort of patients.
Nwaejike
Nnamdi
N
Department of Cardiothoracic Surgery, Derriford Hospital, Plymouth, UK. nnamdi_@hotmail.com
Campalani
Gianfranco
G
Gladstone
Dennis
D
Nzewi
O C
OC
D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000401:mortality* / Q000706:statistics & numerical data; D054869:Clinical Audit; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015994:Incidence; D007423:Intra-Aortic Balloon Pumping / Q000401:mortality* / Q000706:statistics & numerical data*; D008297:Male; D011183:Postoperative Complications / Q000401:mortality*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012041:Regional Medical Programs / Q000706:statistics & numerical data*; D016019:Survival Analysis; D015996:Survival Rate; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology