title: Intra-Aortic Balloon Pump Counterpulsation in the Post-Resuscitation Period is Associated with Improved Functional Outcomes in Patients Surviving an Out-of-Hospital Cardiac Arrest: Insights from a Dedicated Heart Attack Centre.
abstract: BACKGROUND
  Despite advances in cardiopulmonary resuscitation, functional survival remains low after out-of-hospital cardiac arrest (OOHCA). Intra-aortic balloon pump (IABP) therapy has recently been shown to augment cerebral blood flow. Whether IABP therapy in the post-resuscitation period improves functional outcomes is unknown.
  
  
  METHODS
  We analysed 174 consecutive patients who were successfully resuscitated from an OOHCA between 2011-2013 at Harefield Hospital, London. We analysed functional status at discharge and mortality up to one year.
  
  
  RESULTS
  A total of 55 patients (32.1%) received IABP therapy. Comparing those receiving IABP with those not receiving IABP, there was no difference in favourable functional status at discharge (49.1% vs. 57.1%, p=0.321); and mortality at one year (45.5% vs. 35.5%, p=0.164). Multivariable analyses identified IABP therapy as a strong independent predictor for favourable functional status at discharge (OR=7.51, 95% CI: 2.15-26.14, p=0.002) and this association was maintained in propensity-score adjusted analyses (OR=9.90, 95% CI: 2.11-46.33, p=0.004) and inverse probability treatment weighted analyses (OR=10.84, 95% CI: 2.75-42.69, p<0.001). However, IABP therapy was not an independent predictor for mortality at one year (HR=0.93, 95% CI: 0.52-1.65, p=0.810) and this was confirmed in both propensity-score adjusted and inverse probability treatment weighted analyses.
  
  
  CONCLUSIONS
  In this observational analysis of patients surviving an OOHCA, the use of IABP therapy in the post-resuscitation period was associated with improved functional outcomes. This warrants further evaluation in larger prospective studies.
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK. Electronic address: b.iqbal@imperial.ac.uk.
authors.forename: M Bilal
authors.initials: MB
authors.lastname: Iqbal
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Abtehale
authors.initials: A
authors.lastname: Al-Hussaini
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Gareth
authors.initials: G
authors.lastname: Rosser
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Ramyah
authors.initials: R
authors.lastname: Rajakulasingam
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Jayna
authors.initials: J
authors.lastname: Patel
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Katharine
authors.initials: K
authors.lastname: Elliott
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Poornima
authors.initials: P
authors.lastname: Mohan
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Maria
authors.initials: M
authors.lastname: Phylactou
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Green
authors.affiliation: London Ambulance Service, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Whitbread
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK; London Ambulance Service, London, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Mason
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK; London Ambulance Service, London, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Grocott-Mason
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Robert
authors.initials: R
authors.lastname: Smith
authors.affiliation: Department of Cardiology, Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital, Middlesex, UK.
authors.forename: Charles
authors.initials: C
authors.lastname: Ilsley
mesh_terms: D000368:Aged; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000601:surgery*; D011184:Postoperative Period; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods*; D015996:Survival Rate
keywords: Functional survival; Intra-aortic balloon pump; Out-of-hospital cardiac arrest