title: Hemodynamic effects of standard versus larger-capacity intraaortic balloon counterpulsation pumps.
abstract: OBJECTIVE
  Several recent trials have examined the clinical utility of intraaortic balloon counterpulsation pumps (IABPs) in cardiogenic shock and acute coronary syndromes. More recently, a larger-capacity 50 cc IABP was introduced into practice. No data comparing the hemodynamic effects of the 40 cc vs 50 cc IABP exist. Our aim was to explore the hemodynamic effects of the 50 cc IABP in real-world clinical practice.
  
  
  METHODS
  Demographic, hemodynamic, and laboratory data were retrospectively examined in 26 consecutive subjects treated with a 50 cc IABP and compared with 26 patients receiving a 40 cc IABP between 2012 and 2013. IABP tracings were analyzed within 24 hours of implantation in all patients. Pulmonary artery catheter data were available before and after IABP implantation in 20 subjects.
  
  
  RESULTS
  Baseline demographics, including body surface area, were similar between groups. Compared with the 40 cc IABP group, 50 cc IABP recipients showed higher augmented diastolic blood pressure, greater systolic unloading, and a larger reduction in pulmonary capillary occlusion pressure (PCOP). Percent diastolic augmentation was higher among 50 cc IABP recipients. Only 58% of subjects achieved <10 mm Hg of systolic unloading in the 40 cc group compared with 27% in the 50 cc group. For both the 40 cc and 50 cc IABPs, the magnitude of systolic unloading correlated inversely with PCOP and directly with the magnitude of diastolic augmentation.
  
  
  CONCLUSIONS
  In real-world practice, greater systolic unloading and diastolic augmentation were observed among 50 cc vs 40 cc IABP recipients. Future trials evaluating the clinical utility of the 50 cc IABP are required.
authors.affiliation: Tufts University School of Medicine, Division of Cardiology, Boston, MA, USA. nkapur@tuftsmedicalcenter.org.
authors.forename: Navin K
authors.initials: NK
authors.lastname: Kapur
authors.forename: Vikram
authors.initials: V
authors.lastname: Paruchuri
authors.forename: Arjun
authors.initials: A
authors.lastname: Majithia
authors.forename: Michele
authors.initials: M
authors.lastname: Esposito
authors.forename: Henry
authors.initials: H
authors.lastname: Shih
authors.forename: Andrew
authors.initials: A
authors.lastname: Weintraub
authors.forename: Michael
authors.initials: M
authors.lastname: Kiernan
authors.forename: Duc Thinh
authors.initials: DT
authors.lastname: Pham
authors.forename: David
authors.initials: D
authors.lastname: Denofrio
authors.forename: Carey
authors.initials: C
authors.lastname: Kimmelstiel
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D006439:Hemodynamics; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation*; D012189:Retrospective Studies; D012770:Shock, Cardiogenic / Q000628:therapy*