Intra-aortic balloon assistance in cardiogenic shock after myocardial infarction or cardiac surgery

Sixty-eight patients were referred for consideration of intra-aortic balloon assistance, 55 of whom were accepted. Thirty-one patients were in cardiogenic shock after myocardial infarction and the remaining 24 were cardiac surgical patients. Twenty-three of the myocardial infarct group were established on IABA and all 24 of the cardiac surgical patients. Of the 23 patients with cardiogenic shock after myocardial infarction, 19 showed initial haemodynamic improvement on intra-aortic balloon assistance and 5 (22%) survived to leave hospital. Of the 24 cardiac surgical patients, 15 could not be withdrawn from total cardiopulmonary bypass. With intra-aortic balloon assistance, 11 (73%) could be withdrawn from cardiopulmonary bypass and 5 (33%) were hospital and long-term survivors. The remaining 9 surgical patients were in cardiogenic shock in the early postoperative phase, though 5 showed initial haemodynamic improvement there was only one hospital survivor in this group. Intra-aortic balloon assistance was, therefore, of most value in patients de-pendent on cardiopulmonary bypass. The survyival in patients with cardiogenic shock after myocardial in-farction was marginally improved. The principle of intra-aortic balloon counterpulsa-tion was first suggested by Moulopoulos et al. (1962), and it was subsequently developed for use in cardiogenic shock after myocardial infarction. A balloon catheter positioned at the top of the descend-ing aorta is inflated in diastole and augments the aortic diastolic pressure, thus increasing coronary artery perfusion. With balloon deflation before the beginning of ventricular systole, left ventricular afterload is reduced, with a consequent reduction in ventricular oxygen consumption. A number of patients with cardiogenic shock have now been treated in this way (Kantrowitz et al., 1968b; Dunkman et al., 1972; Scheidt et al., 1973; O'Rourke et al., 1975). Hospital survival may be improved using this technique but authors have varied in the criteria used for concomitant corrective surger