麻豆传媒

It was feasible to perform intra-aortic balloon pump (IABP) insertions in the cardiac intensive care unit (ICU) without transferring patients to the catheterization laboratory, according to Italian clinicians.

In this single-center study, bedside IABP placement under echocardiographic guidance resulted in correct device positioning at chest X-ray in 82.9% of cases, which was similar to the 82.5% after fluoroscopic-guided IABP insertion in the cath lab, reported Luca Baldetti, MD, of San Raffaele Hospital in Milan, and colleagues.

The rate of IABP-related major vascular complications was similar between groups as well (5.7% vs 5.0%), they noted in .

"Baldetti et al have shown that TTE [transthoracic echocardiography] and TEE [transesophageal echocardiography] can be used at the bedside to correctly confirm IABP placement without the increased risk of complications compared to those who undergo the procedure in the cath lab,” commented Courtney Bennett, DO, a critical care cardiologist at the Mayo Clinic in Rochester, Minnesota.

"Patients in the cardiac ICU have become increasingly more complex, with more comorbidities, and bringing care to the patient is the future of medicine," she told 麻豆传媒.

Baldetti and team explained that IABP placement in the ICU, with simple femoral access and local or general anesthesia, may be attractive to patients with cardiogenic shock (CS) who may not otherwise need coronary angiography or other urgent cath lab procedures.

"Interestingly, despite decades of IABP utilization, no study specifically compared this approach to the fluoroscopic‐guided insertion," they wrote.

"The relatively low profile of IABP insertion sheath, coupled with its easy implant technique make it an attractive device for rapid bedside deployment. The clinical outlook of this report is strengthened by the recent reappraisal of the value of IABP in specific settings of CS, and by the increasing use of IABP in the setting of ADHF [acute decompensated heart failure] with hypoperfusion," they continued.

The study included 115 patients who received an IABP by transfemoral insertion at Baldetti's institution from June 2020 to October 2021. Median patient age was 69.4 years, and 23.5% were women. Etiology of CS was was split between acute coronary syndrome (55.7%) and ADHF (44.3%).

Of the total cohort, 35 patients had their devices placed bedside. Compared with the cath lab group, these patients were more likely to have:

• ADHF as the etiology of CS
• Pre-existing heart failure
• Lower systolic blood pressure
• Worse left ventricular ejection fraction
• A greater prevalence of right ventricular failure
• More severe tricuspid regurgitation
• More severe mitral regurgitation
• A greater need for inotropes and vasopressors

None of the patients with attempted bedside IABP positioning converted to a cath lab insertion because of a poor echocardiographic window. One person was transferred to the cath lab after the IABP shaft was unable to be advanced due to an extremely tortuous ilio-femoral axis, Baldetti and colleagues noted.

Patients with bedside IABP insertion experienced longer cardiac ICU stays (18.0 vs 11.1 days, P=0.017) and a higher rate of left ventricular assist device implantation (17.1% vs 0.0%, P<0.001) during index hospitalization. There was also a trend for increased in-hospital death that did not reach statistical significance (28.6% vs 17.5%, P=0.179).

There were no differences in duration of IABP support, need for mechanical circulatory support escalation, need for renal replacement therapy, sepsis, or stroke between the bedside and cath lab groups. Use of invasive mechanical ventilation was similarly high between groups (65.7% vs 61.2%, P=0.649).

Baldetti and team acknowledged that their study sample was small and that there may have been a learning curve for operators, given the necessary expertise in arterial puncture and Seldinger technique.

"Finally, a mobile C-arm may offer the unique possibility to attempt bedside insertion while maintaining a direct real-time fluoroscopic view during guidewires manipulation and IABP shaft advancement: if available, this method combined with echocardiography may be the preferred approach for bedside IABP implant," they suggested.

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