title: The impact of intra-aortic balloon pump weaning protocols on in-hospital clinical outcomes.
abstract: BACKGROUND
  Current literature recommends weaning intra-aortic balloon pump (IABP) support prior to discontinuation. To date, no studies have compared various weaning strategies for safety or efficacy. This study was designed to evaluate the impact of weaning on in-hospital clinical outcomes.
  
  
  METHODS
  From 5/1/07 through 5/1/09 429 patients receiving IABP therapy were retrospectively identified using CPT1 billing codes. The study population and clinical outcomes analysis were stratified by use of weaning protocols versus immediate discontinuation of the IABP. In a subset analysis the patients receiving weaning protocols prior to IABP discontinuation were stratified for further analysis of clinical outcomes by whether they had received 1:3 ratio counterpulsation during their wean or whether they only received 1:2 counterpulsation prior to IABP discontinuation. These groups were analyzed for differences in primary and secondary end-points.
  
  
  RESULTS
  Of the 429 patients identified, 344 (80.2%) were weaned prior to IABP discontinuation and 85 (19.8%) of the patients had their IABP abruptly discontinued. Patients not weaned had a lower heart rate after IABP discontinuation than those weaned, but no difference in systolic and mean blood pressure or urine output. There was no significant difference in mortality. Weaning was associated with a nonsignificant trend toward increased length of stay.
  
  
  CONCLUSIONS
  This study suggests that weaning protocols offer no hemodynamic benefits or improvement in in-hospital mortality rates. Weaning is associated with trend toward increased length of stay. We conclude that weaning offers no advantage over direct device removal and would advocate that balloon pumps be directly withdrawn when counterpulsation is terminated.
authors.affiliation: Department of Cardiovascular Medicine, William Beaumont Hospital, Royal Oak, Michigan 48073, USA. vinayak.manohar@beaumont.edu
authors.forename: Vinayak A
authors.initials: VA
authors.lastname: Manohar
authors.forename: Robert N
authors.initials: RN
authors.lastname: Levin
authors.forename: Sevan S
authors.initials: SS
authors.lastname: Karadolian
authors.forename: Aimen
authors.initials: A
authors.lastname: Usmani
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Timmis
authors.forename: Megan E
authors.initials: ME
authors.lastname: Dery
authors.forename: Simon R
authors.initials: SR
authors.lastname: Dixon
mesh_terms: D000368:Aged; D002985:Clinical Protocols; D020878:Device Removal / Q000379:methods*; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*