Intra-Aortic Balloon Counterpulsation in Cardiogenic Shock

Eighty-seven patients with cardiogenic shock were treated with the intra-aortic counterpulsating balloon in 10 institutions according to a common protocol. Clinical and physiologic responses were favorable in most patients. Heart rate fell from 110 ± 24 (mean ± S.D.) to 103 ± 21 beats per minute, systolic arterial pressure ("afterload") fell from 76 ± 22 to 57 ± 17 mm Hg, diastolic arterial pressure increased from 53 ± 12 to 83 ± 19 mm Hg, and mean arterial pressure did not change. Cardiac output increased 500 ml per minute, and a decrease in lactate production or increase in lactate extraction by the myocardium occurred in 18 of 19 patients with metabolic studies. Fifty-two patients died during balloon assistance, and 35 survived; 15 of the survivors left the hospital, and eight have lived for more than one year. Attempts to predict survival in advance, or from response to balloon counterpulsation, were generally unsuccessful, and precise indications for initiation and termination of balloon counterpulsation remain in doubt. (N Engl J Med 288:979–984, 1973)