title: Efficacy and safety of preoperative intra-aortic balloon pump use in patients undergoing cardiac surgery: a systematic review and meta-analysis.
abstract: BACKGROUND
  Intra-aortic balloon pump (IABP) can be used prior to coronary artery bypass graft surgery (CABG) in high-risk patients. Whether this technique remains safe and effective in contemporary practice is controversial.
  
  
  OBJECTIVE
  We have completed a systematic review and meta-analysis of randomized trials and observational studies to evaluate the safety and benefits of IABP prior to CABG surgery.
  
  
  METHODS
  We searched PubMed, EMBASE, Cochrane Library databases, with cross-referencing of relevant articles for studies assessing the impact of IABP prior to and after isolated CABG. Two investigators independently sorted the potentially relevant studies, and three extracted data. The assessed outcomes included in-hospital and 30-day mortality, IABP-related complications and length of intensive care unit and hospital stay.
  
  
  RESULTS
  From 1977 to 2015 we included 11 randomized controlled trials (n=1293) (RCTs) and 22 observational studies, including a total of 46,067 patients. Analyses from RCTs suggested that IABP prior to CABG was associated with a significant reduction in hospital mortality (odds ratio (OR) 0.20; 95% confidence interval (CI): 0.09-0.44; P<0.0001) and 30-day mortality compared to no preoperative IABP (OR 0.43, 95% CI: 0.25-0.76; P=0.003). IABP prior to CABG was also associated with shorter intensive care unit (weighted mean difference (WMD) -1.47day; 95% CI: -1.82 to -1.12day; P<0.00001) and hospital length of stay (WMD -3.25days; 95% CI: -5.18 to -1.33days; P=0.0009). However, there were significant bias and limitations among included studies. Furthermore, results for similar outcomes from observational studies remained inconclusive.
  
  
  CONCLUSIONS
  In contemporary practice, evidence showing clinical benefit for preoperative IABP in high-risk patients remains limited and requires further validation in an appropriately sized multicenter randomized trial.
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec (Quebec), Canada.
authors.forename: Yann
authors.initials: Y
authors.lastname: Poirier
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec (Quebec), Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec (Quebec), Canada.
authors.forename: Guillaume
authors.initials: G
authors.lastname: Plourde
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec (Quebec), Canada.
authors.forename: Goran
authors.initials: G
authors.lastname: Rimac
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec (Quebec), Canada.
authors.forename: Alberto
authors.initials: A
authors.lastname: Barria Perez
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec (Quebec), Canada.
authors.forename: Olivier
authors.initials: O
authors.lastname: Costerousse
authors.affiliation: Quebec Heart-Lung Institute, Laval University, Quebec (Quebec), Canada. Electronic address: Olivier.bertrand@crhl.ulaval.ca.
authors.forename: Olivier F
authors.initials: OF
authors.lastname: Bertrand
mesh_terms: D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay / Q000639:trends; D064887:Observational Studies as Topic / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011300:Preoperative Care / Q000009:adverse effects / Q000379:methods*; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cardiac surgery; IABP; Meta-analysis; Preoperative IABP