Initial clinical experience with intraaortic balloon pumping in cardiogenic shock

Our intraaortic cardiac assistance system for patients in cardiogenic shock following myocardial infarction consists of a catheter and balloon inserted through a femoral arteriotomy into the thoracic aorta. The pumping chamber, activated by helium, is synchronized with the heart by signals from the electrocardiogram or the central aortic pressure transducer. Pumping improved two patients' circulatory status; one survived. Two patients died before pumping could begin; in another, an abdominal aortic aneurysm prevented insertion of the pump. Thrombosis did not occur during pumping; hemolysis appeared minimal. Although final evaluation must await more data, balloon pumping appears to be effective in cardiogenic shock. Further study may establish a place for the procedure in myocardial infarction without cardiogenic shock and in low cardiac output syndromes associated with open-heart surgery.