Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial

• Published in: Critical care medicine Vol. 46; no. 8; p. e742
• Main Authors: Rocha Ferreira, Graziela Santos, de Almeida, Juliano Pinheiro, Landoni, Giovanni, Vincent, Jean Louis, Fominskiy, Evgeny, Gomes Galas, Filomena Regina Barbosa, Gaiotto, Fabio A, Dallan, Luís Oliveira, Franco, Rafael Alves, Lisboa, Luiz Augusto, Palma Dallan, Luis Roberto, Fukushima, Julia Tizue, Rizk, Stephanie Itala, Park, Clarice Lee, Strabelli, Tânia Mara, Gelas Lage, Silvia Helena, Camara, Ligia, Zeferino, Suely, Jardim, Jaquelline, Calvo Arita, Elisandra Cristina Trevisan, Caldas Ribeiro, Juliana, Ayub-Ferreira, Silvia Moreira, Costa Auler, Jr, Jose Otavio, Filho, Roberto Kalil, Jatene, Fabio Biscegli, Hajjar, Ludhmila Abrahao
• Format: Journal Article
• Language: English
• Published: United States 01.08.2018
• ISSN: 1530-0293
• DOI: 10.1097/CCM.0000000000003185

The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. Heart Institute of São Paulo University. High-risk patients undergoing elective coronary artery bypass surgery. Patients were randomized to receive preskin incision intra-aortic balloon pump insertion after anesthesia induction versus no intra-aortic balloon pump use. The primary outcome was a composite endpoint of 30-day mortality and major morbidity (cardiogenic shock, stroke, acute renal failure, mediastinitis, prolonged mechanical ventilation, and a need for reoperation). A total of 181 patients (mean [SD] age 65.4 [9.4] yr; 32% female) were randomized. The primary outcome was observed in 43 patients (47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in the control group (p = 0.46). The median duration of inotrope use (51 hr [interquartile range, 32-94 hr] vs 39 hr [interquartile range, 25-66 hr]; p = 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4 d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic balloon pump group than in the control group. A meta-analysis of 11 randomized controlled trials confirmed a lack of survival improvement in high-risk cardiac surgery patients with perioperative intra-aortic balloon pump use. In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.