title: Extracorporeal life support for cardiogenic shock: influence of concomitant intra-aortic balloon counterpulsation.
abstract: OBJECTIVE
  Intra-aortic balloon counterpulsation (IABP) during extracorporeal life support (ECLS) for cardiogenic shock may improve pulsatility and coronary perfusion, thereby promoting recovery of cardiac function. However, the risks and benefits of IABP during ECLS in real clinical settings have not been evaluated. This study aims to evaluate the effect of IABP on the early outcome of ECLS for cardiogenic shock.
  
  
  METHODS
  We evaluated 253 adult patients (aged 58.8 ± 15.3 [mean ± standard deviation] years, 154 males) undergoing ECLS for cardiogenic shock from January 2005 to August 2012. Of them, 60 patients underwent concomitant IABP (IABP group) and 193 underwent ECLS only (control group). In-hospital outcomes were compared using the inverse probability of treatment weighting based on propensity scores.
  
  
  RESULTS
  The indications for ECLS were low cardiac output after cardiac surgery in 118 patients (46.6%), heart failure in 71 (28.1%), acute myocardial infarction in 49 (19.4%) and others in 15 (5.9%). Successful ECLS weaning rate was significantly higher in the IABP group than in the control group (61.7 vs 42.0%, P = 0.008); however, there was no significant difference in in-hospital mortality between the two groups (68.6 vs 72.0%, P = 0.58). After adjustment for propensity of treatment assignment conditional on baseline characteristics, the IABP group showed a decreased risk of weaning failure (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.28-0.92, P = 0.024) but with a similar risk of in-hospital mortality (OR 0.85; 95% CI 0.46-1.60; P = 0.62) compared with the control group.
  
  
  CONCLUSIONS
  The use of IABP during ECLS increased a successful ECLS weaning rate, but was not translated into improved survival. Studies on larger populations may verify the survival effect of IABP during ECLS.
authors: Department of Thoracic and Cardiovascular Surgery, Hanyang University Guri Hospital, Seoul, South Korea Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors: Sun Kyun
authors: SK
authors: Ro
authors: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea jbkim1975@amc.seoul.kr.
authors: Joon Bum
authors: JB
authors: Kim
authors: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors: Sung Ho
authors: SH
authors: Jung
authors: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors: Suk Jung
authors: SJ
authors: Choo
authors: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors: Cheol Hyun
authors: CH
authors: Chung
authors: Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
authors: Jae Won
authors: JW
authors: Lee
mesh_terms: D000368:Aged; D005112:Extracorporeal Circulation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects* / Q000379:methods; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000453:epidemiology / Q000601:surgery*; D016896:Treatment Outcome
keywords: Cardiogenic shock; Extracorporeal life support; Intra-aortic balloon counterpulsation