The Use of Intra-Aortic Balloon Pumping in Cardiac Surgery

All articles of this category (opens in new window) Table of Contents 2. PUBLISHING MEDICAL SOCIETY S107 3. WHAT'S NEW? S107 4. SCOPE AND PURPOSE S108 4.1. Health care setting S108 4.2. Target audience S108 4.3. 1.5 Additional documents relating to this guideline S109 5. INTRODUCTION S109 5.1. Basic principles of intra-aortic balloon counterpulsation S109 5.2. Current use of IABP in cardiac surgery S109 5.3. Currently available guidelines on IABP in cardiac surgery patients S110 5.4. Objectives and clinical questions of this updated Clinical Practice Guideline S111 6. IABP AS A THERAPEUTIC SUPPORTIVE METHOD S111 6.1. Definition of therapeutic IABP S111 6.2. Should IABP be used in acute decompensated heart failure? S111 6.2.1. Key question 1: Should IABP be used in infarct-related CS? S111 6.2.2. Description of the evidence for IABP versus no IABP in Infarct-Related CS S112 6.2.3. Key question 2: Should IABP be used in patients with decompensated valve defects (mitral valve regurgitation, aortic valve stenosis)? S114 6.2.4. Key question 3: Should IABP be used in patients with mechanical complications of acute myocardial infarction? S114 6.2.5. Key question 4: Should IABP be used in patients with right-heart failure? S115 6.2.6. Key question 5: Should IABP be used in acute decompensation of chronic heart failure? S116 6.2.7. Key question 6: Should IABP be used in postoperative low cardiac output syndrome (LCOS) after cardiac surgery? S117 7. IABP AS A PROPHYLACTIC SUPPORTIVE METHOD S118 7.1. Key question 7: What is the definition of prophylactic IABP use? S118 7.2. Key question 8: Should IABP be used prophylactically in high-risk patients prior to cardiac surgery? S118 7.3. Key question 9: What are suitable criteria for high-risk patients who would benefit from prophylactic IABP implantation? S122 7.4. Key question 10: Should IABP be used during extracorporeal circulation to generate pulsatile perfusion? S123 7.5. Key question 11: When should an IABP be implanted prophylactically? S127 7.6. Key question 12: Under what conditions should IABP be used to support weaning from CPB? S128 8. MANAGEMENT OF IABP S129 8.1. Key question 13: What access routes are available for IABP implantation, and which should be used? S129 8.2. Key question 14: Should IABP be implanted with or without a sheath? S129 8.3. Key question 15: How should balloon sizes be selected? S130 8.4. Key question 16: What are the target parameters for successful IABP therapy? S131 8.5. Key question 17: What kind of monitoring should be performed during IABP therapy? S131 8.6. Key question 18: How should blood coagulation be controlled during IABP therapy? S132 8.7. Weaning from IABP S134 8.7.1. Key question 19: Is gradual weaning from IABP generally advisable? S134 8.7.2. Key question 20: When should weaning be induced, and/or which parameters should be considered as predictors of successful weaning? S135 8.7.3. Key question 21: Which weaning method (assist ratio reduction versus volume reduction) is preferable? S136 8.7.4. Key question 22: What is the maximum duration that IABP should be used for? S137 8.7.5. Key question 23: What are the contraindications of IABP therapy? S138 8.8. What nursing measures are relevant in the care of IABP patients? S139 8.8.1. Key question 24: How should the arterial catheter puncture site be treated in patients with an indwelling IABP? S139 8.8.2. Key question 25: How should patients with an indwelling IABP be positioned, mobilised, and managed for pressure ulcer prevention? S141 9. IABP IN THE CONTEXT OF OTHER MCS METHODS S142 9.1. Key question 26: How should the indications for IABP implantation be established in the different clinical settings versus other MCS methods? S142 9.2. Key question 27: Should IABP be used in combination with other MCS methods? S143 9.3. KEY QUESTION 28: SHOULD IABP BE USED IN CHILDREN AND ADOLESCENTS? S144 10. CONSTITUTION OF THE GUIDELINE DEVELOPMENT GROUP S145 10.1. Guideline coordinator/contact person S145 12. REFERENCES[ S145 ] Publication History Article published online: 08 June 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany