Intra-Aortic Balloon Pump Therapy

Basic Principles and Indications

The European Society of Cardiology recommends the use of Intra-Aortic Balloon Pump (IABP) for patients with cardiogenic shock or severe acute left heart failure that does not respond to conventional therapy, especially when there is potential for myocardial recovery or as a bridge to definitive treatment 1
IABP provides hemodynamic support through two primary mechanisms: diastolic augmentation and systolic unloading, with the balloon inflating and deflating in synchrony with the cardiac cycle 2
The American Heart Association suggests that synchronized IABP is performed by inflating and deflating a 30-50 mL balloon placed in the thoracic aorta through the femoral artery, with the goal of increasing aortic diastolic pressure and coronary flow, improving myocardial oxygen supply 1
The European Heart Society indicates that deflation during systole decreases afterload and facilitates left ventricular emptying, reducing myocardial work 1, 2

The American College of Cardiology recommends ensuring proper balloon positioning within the aorta to achieve adequate augmentation, verifying balloon membrane integrity and proper inflation volume, and assessing for tachyarrhythmias which can reduce diastolic time and limit effective augmentation 3
The European Society of Cardiology suggests maintaining adequate preload through careful volume assessment and management, and considering adding inotropic and/or vasopressor support if needed to maintain adequate perfusion while optimizing IABP function 3
For patients with refractory cardiac failure despite IABP, early consideration of more advanced mechanical circulatory support is recommended by the American Heart Association 4, 3
The American College of Cardiology recommends a weaning protocol that includes ensuring patient has stable hemodynamics with minimal inotropic support before initiating weaning, beginning weaning by decreasing the assist ratio while monitoring hemodynamic stability, and monitoring for signs of inotrope dependency during weaning 2, 3

The European Society of Cardiology indicates that IABP is indicated for cardiogenic shock or severe acute left heart failure that does not respond rapidly to fluid administration, vasodilation, and inotropic support, heart failure complicated by significant mitral regurgitation or rupture of the interventricular septum, and severe myocardial ischemia 1
The American Heart Association recommends that IABP is contraindicated in patients with aortic dissection or significant aortic insufficiency, severe peripheral vascular disease, uncorrectable causes of heart failure, and multi-organ failure 1

A meta‑analysis of patients undergoing primary percutaneous coronary intervention for cardiogenic shock found that IABP use was associated with a 6 % absolute increase in 30‑day mortality (95 % confidence interval 3–10 %; P = 0.0008)【5】.

The same meta‑analysis reported that IABP use increased the risk of stroke by 2 % (95 % CI 0–4 %; P = 0.03) and bleeding by 6 % (95 % CI 1–11 %; P = 0.02) in the studied cohorts【5】.