[ 55] Student’s Page Intra-aortic Balloon Counter Pulsation

Intra-aortic balloon pump (IABP) is a temporary mechanical circulatory assist device. It consists of a sausage-shaped balloon mounted on a catheter and placed in the descending thoracic aorta. By inflating during diastole and deflating during systole, it results in augmentation of the diastolic perfusion pressure and systolic unloading. The overall effects are an increased coronary perfusion, reduction in myocardial ischemia, reduced preload, afterload and myocardial oxygen demand, increased cardiac output, and peripheral perfusion. Due to these remarkable hemodynamic changes the device is very useful in situations requiring circulatory support in the presence of ischemic/failing heart. Indications Registry data from the SHOCK trial (SHould we emergently revascularise Occluded coronaries for Cardiogenic shocK) suggested that in patients with acute myocardial infarction (MI) who received thrombolytic therapy, use of IABP support resulted in reduced hospital mortality compared to the patients in whom thrombolytic therapy alone was used (47 % vs. 63%; p<0.0001) (1). Since then, the guidelines on acute MI (ACC/AHA as well as the ESC) recommend that IABP should be used in patients of acute infarction in whom cardiogenic shock cannot be quickly reversed with pharmacologic therapy (class I indication). Other appropriate indications for the use of IABP are shown in Table 1. Table 1