title: Usefulness of Intra-aortic Balloon Pump Counterpulsation.
abstract: Intra-aortic balloon pump (IABP) counterpulsation is the most widely used mechanical circulatory support device because of its ease of use, low complication rate, and fast manner of insertion. Its benefit is still subject of debate, and a considerable gap exists between guidelines and clinical practice. Retrospective nonrandomized studies and animal experiments show benefits of IABP therapy. However, recent large randomized trials do not show benefit of IABP therapy, which has led to a downgrading in the guidelines. In our view, this dichotomy between trials and practice might be the result of insufficient understanding of the prerequisites needed for effective IABP therapy, that is, exhausted autoregulation, and of not including the right patient population in trials. The population included in recent large randomized trials has been heterogeneous, also including patients in whom benefit of IABP could not be expected. The clinical condition in which most benefit is expected, that is persistent ischemia in acute ST-elevation myocardial infarction, is discussed in this review. In conclusion, this review aims to explain the physiological principles needed for effective IABP therapy, to reflect critically on the large randomized trials, and to solve some of the controversies in this field.
authors.affiliation: Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands.
authors.forename: Lokien X
authors.initials: LX
authors.lastname: van Nunen
authors.affiliation: Center for Intensive Internal Medicine, University Medical Center, Ljubljana, Slovenia.
authors.forename: Marko
authors.initials: M
authors.lastname: Noc
authors.affiliation: The Cardiovascular Center, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Navin K
authors.initials: NK
authors.lastname: Kapur
authors.affiliation: Division of Cardiology, Department of Medicine, Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Manesh R
authors.initials: MR
authors.lastname: Patel
authors.affiliation: Cardiovascular Division, British Heart Foundation Centre of Research Excellence, Kings College London, St Thomas' Hospital, London, United Kingdom.
authors.forename: Divaka
authors.initials: D
authors.lastname: Perera
authors.affiliation: Department of Cardiology, Catharina Hospital Eindhoven, Eindhoven, The Netherlands. Electronic address: Nico.Pijls@inter.nl.net.
authors.forename: Nico H J
authors.initials: NH
authors.lastname: Pijls
mesh_terms: D000818:Animals; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000379:methods*; D009203:Myocardial Infarction / Q000150:complications; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy*