title: Intra-aortic balloon counterpulsation in the treatment of infarction-related cardiogenic shock--review of the current evidence.
abstract: The European ST-elevated myocardial infarction (STEMI) guideline suggested the intra-aortic balloon pump (IABP) with a recommendation level I and a level of evidence C as an effective measure in combination with balloon angioplasty in patients with cardiogenic shock (CS), stent implantation, and inotropic and vasopressor support. Similarly, upon mechanical complication due to myocardial infarction (MI), the guideline suggests that in patients with a ventricular septal defect or in most patients with acute mitral regurgitation, preoperative IABP implantation is indicated for circulatory support. The American College of Cardiology/American Heart Association STEMI guideline recommends the use of the IABP with a recommendation level I and a level of evidence B if CS does not respond rapidly to pharmacological treatment. The guideline notes that the IABP is a stabilizing measure for angiography and early revascularization. Even in MI complications, the use of preoperative IABP is recommended before surgery. Within this overview, we summarize the current evidence on IABP use in patients with CS complicated by MI. From our Cochrane data analysis, we conclude that in CS due to acute MI (AMI) treated with adjuvant systemic fibrinolysis, the IABP should be implanted. In patients with CS following AMI, treated with primary percutaneous coronary intervention (PCI), the IABP can be implanted, although data are not distinctive (i.e., indicating positive and negative effects). In the future, randomized controlled trials are needed to determine the use of IABP in CS patients treated with PCI. When patients with CS are transferred to a PCI center with or without thrombolysis, patients should receive mechanical support with an IABP. To treat mechanical MI complications-in particular ventricular septal defect-patients should be treated with an IABP to stabilize their hemodynamic situation prior to cardiac surgery. Similar recommendations are given in the German Austrian guidelines on treatment of infarction-related CS patients (http://www.awmf.org/leitlinien/detail/ll/019-013.html).
authors.affiliation: Departments of Medicine III Cardio-Thoracic-Surgery, Martin-Luther-University, Halle/Salle, Germany. michael.buerke@medizin.uni-halle.de
authors.forename: Michael
authors.initials: M
authors.lastname: Buerke
authors.forename: Roland
authors.initials: R
authors.lastname: Prondzinsky
authors.forename: Henning
authors.initials: H
authors.lastname: Lemm
authors.forename: Sebastian
authors.initials: S
authors.lastname: Dietz
authors.forename: Ute
authors.initials: U
authors.lastname: Buerke
authors.forename: Henning
authors.initials: H
authors.lastname: Ebelt
authors.forename: Hasan
authors.initials: H
authors.lastname: Bushnaq
authors.forename: Rolf-Edgar
authors.initials: RE
authors.lastname: Silber
authors.forename: Karl
authors.initials: K
authors.lastname: Werdan
mesh_terms: D005060:Europe; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy; D017410:Practice Guidelines as Topic; D012770:Shock, Cardiogenic / Q000150:complications* / Q000601:surgery*; D015912:Thrombolytic Therapy; D014481:United States