Reinsertion Predictors of Intraaortic Balloon Pumps

The reinsertion rate of intraaortic balloon pumps (IABP) has not been clearly reported. We evaluated the use of left-ventricular ejection fraction (LVEF), fractional shortening (FS), and cardiac index (CI) values to asses cardiac performance as weaning criteria for IABP in a prospective study performed in 100 patients who required IABP. Patients were randomly divided into 2 groups of 50 patients. In group 1, classical hemodynamic criteria were considered as weaning criteria of IABP. In this group, IABPs were removed when measurements of general hemodynamic criteria were established to be in normal ranges. In group 2, LVEF, FS, and CI values reflecting cardiac performance were used to monitor patients under IABP support, and IABPs were removed when LVEF, FS, and CI values reached >30%, >20%, and >2.4 L/min per m2, respectively. Reinsertion of IABP was necessary in 13 patients in group 1 and in 9 patients in group 2 (P = .48). Vascular complications were the main cause of reinsertion of IABP in 7 and 9 patients in group 1 and group 2, respectively (P = .59). Nine patients died in group 1 and 2 in group 2 (P = .025). In group 1, death due to myocardial dysfunction occurred in 8 of 13 patients (62%) who had required reinsertion of IABP; 6 of these patients required reinsertion of IABP because of hemodynamic deterioration, whereas no patients in group 2 required reinsertion of IABP because of hemodynamic deterioration (P = .027). LVEF, FS, and CI values higher than 30% (P = .008), 20% (P = .005), and 2.4 L/min per m2 (P = .013), respectively, showed good outcomes in regard to avoiding reinsertion of IABP, indicating that these measurements were significant predictors for reinsertion of IABP.