Question 22

Outline  the  indications  for and  the  potential  complications  of Intra-Aortic Balloon Pump (IABP) insertion.

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College Answer

Indications for IABP insertion include:
•    Prophylactic (eg. cardiac surgery left main with unstable angina; or non cardiac surgery with severe Left Ventricular impairment)
•    Failure to wean from CPB
•    Cardiogenic shock – acute MR/VSD
•    Support for re-perfusion/revascularisation
•    Bridge to heart transplant

Potential complications include:
•    Limb ischemia
•    Vascular trauma, dissection
•    Infection
•    Balloon rupture
•    Bleeding

•    Thrombocytopenia
•    Malposition, vascular obstruction
•    Malfunction, failure to unwrap


Indications for insertion and complications of use of IABPs are discussed in greater detail elsewhere.

In brief summary:

Indications for IABP use:

No choice but pump

  • Failure to come off bypass
  • Severe ischaemic mitral regurgitation or ventricular septal defect
    with haemodynamic compromise, while waiting for repair

Probably harmless, but probably not useful

  • High risk CABG patients (pre-op)
  • High-risk PCI patients (pre-op)
  • Cardiogenic shock while waiting for PCI
  • Pulmonary oedema in spite of maximal medical management

Totally experimental

  • Takotsubo cardiomyopathy
  • Neurogenic stress cardiomyopathy of subarachnoid haemorrhage
  • Severe aortic stenosis with cardiogenic shock

Complications of IABP use:

  • Common complications
    • Mild limb ischaemia - 2.9%
    • Balloon leak - 1.0%
    • Major limb ischaemia - 0.9%
    • Haemorrhage - 0.8%
    • Leg amputation due to ischaemia - 0.1%
  • Rare complications
    • Atheromatous cholesterol emboli
    • Aortic or arterial dissection
    • Cerebrovascular accident
    • Thrombocytopenia
    • Haemolysis
    • Helium embolism


Ranucci, Marco, et al. "A Randomized Controlled Trial of Preoperative Intra-Aortic Balloon Pump in Coronary Patients With Poor Left Ventricular Function Undergoing Coronary Artery Bypass Surgery." Critical care medicine (2013). 2013 Nov;41(11):2476-83.


Theologou, Thomas, et al. "Preoperative intra aortic balloon pumps in patients undergoing coronary artery bypass grafting." Cochrane Database Syst Rev 1 (2011).


Ohman, E. Magnus, et al. "Use of aortic counterpulsation to improve sustained coronary artery patency during acute myocardial infarction. Results of a randomized trial. The Randomized IABP Study Group." Circulation 90.2 (1994): 792-799.

Gutfinger, Dan E., et al. "Aggressive preoperative use of intraaortic balloon pump in elderly patients undergoing coronary artery bypass grafting." The Annals of thoracic surgery 67.3 (1999): 610-613.


Thiele H, Zeymer U, Neumann FJ, Ferenc M, Olbrich HG, Hausleiter J, Richardt G, Hennersdorf M, Empen K, Fuernau G, Desch S, Eitel I, Hambrecht R, Fuhrmann J, Böhm M, Ebelt H, Schneider S, Schuler G, Werdan K; IABP-SHOCK II Trial Investigators: Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 2012, 367:1287-1296


Parissis, Haralabos, et al. "The need for intra aortic balloon pump support following open heart surgery: risk analysis and outcome." J Cardiothorac Surg 5 (2010): 20.


Eagle, Kim A., et al. "ACC/AHA 2004 guideline update for coronary artery bypass graft surgery: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee to Update the 1999 Guidelines for Coronary Artery Bypass Graft Surgery)." Circulation 110.14 (2004): e340.


BUCKLEY, MORTIMER J., et al. "Intra-aortic balloon pump assist for cardiogenic shock after cardiopulmonary bypass.Circulation 48.1S3 (1973): III-90.


Sjauw, Krischan D., et al. "A systematic review and meta-analysis of intra-aortic balloon pump therapy in ST-elevation myocardial infarction: should we change the guidelines?." European heart journal 30.4 (2009): 459-468.


Unverzagt, Susanne, et al. "Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock." Cochrane Database Syst Rev 7 (2011).


Perera, Divaka, et al. "Elective intra-aortic balloon counterpulsation during high-risk percutaneous coronary intervention." JAMA: the journal of the American Medical Association 304.8 (2010): 867-874.


GOLD, HERMAN K., et al. "Intraaortic balloon pumping for ventricular septal defect or mitral regurgitation complicating acute myocardial infarction." Circulation 47.6 (1973): 1191-1196.


Kettner, Jiri, et al. "Utility of Intra-Aortic Balloon Pump Support for Ventricular Septal Rupture and Acute Mitral Regurgitation Complicating Acute Myocardial Infarction."The American journal of cardiology (2013).


Aksoy, Olcay, et al. "Cardiogenic shock in the setting of severe aortic stenosis: role of intra-aortic balloon pump support." Heart 97.10 (2011): 838-843.


Lazaridis, Christos, et al. "Intra-aortic balloon pump counterpulsation in the setting of subarachnoid hemorrhage, cerebral vasospasm, and neurogenic stress cardiomyopathy. Case report and review of the literature." Neurocritical care 13.1 (2010): 101-108.


Madhavan  M., Rihal  C.S., Lerman  A., Prasad  A.; Acute heart failure in apical ballooning syndrome (takotsubo syndrome/stress cardiomyopathy): clinical correlates and Mayo Clinic risk score. J Am Coll Cardiol. 57 2011:1400-1401.


Braunwald, Eugene, et al. "ACC/AHA 2002 guideline update for the management of patients with unstable angina and non–ST-segment elevation myocardial infarction—summary articlea report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Committee on the Management of Patients With Unstable Angina)." Journal of the American College of Cardiology 40.7 (2002): 1366-1374.


Yutani, Chikao, et al. "CEREBRO‐SPINAL INFARCTION CAUSED BY ATHEROMATOUS EMBOLI." Pathology International 35.4 (1985): 789-801.


Ho, A. C., et al. "Stroke after intraaortic balloon counterpulsation associated with mobile atheroma in thoracic aorta diagnosed using transesophageal echocardiography." Chang Gung medical journal 25.9 (2002): 612-616.


Kvilekval, Kara HV, et al. "Complications of percutaneous intra-aortic balloon pump use in patients with peripheral vascular disease." Archives of Surgery 126.5 (1991): 621.


Rius, Jordi Bañeras, et al. "Resolution of Shock-Induced Aortic Regurgitation With an Intraaortic Balloon Pump." Circulation 124.4 (2011): e131-e131.


Ferguson, James J., et al. "The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry." Journal of the American College of Cardiology 38.5 (2001): 1456-1462.


Alderman, James D., et al. "Incidence and management of limb ischemia with percutaneous wire-guided intraaortic balloon catheters." Journal of the American college of Cardiology 9.3 (1987): 524-530.


Pennington, D. Glenn, et al. "Intraaortic balloon pumping in cardiac surgical patients: a nine-year experience." The Annals of thoracic surgery 36.2 (1983): 125-131.


Cruz-Flores, Salvador, Alan L. Diamond, and Enrique C. Leira. "Cerebral air embolism secondary to intra-aortic balloon pump rupture." Neurocritical Care 2.1 (2005): 49-50.


HIROOKA, KAZUNOBU, et al. "Helium Gas Embolism caused by a Ruptured Intraaortic Balloon." Japanese Journal of Intensive Care Medicine 27.9 (2003): 867-871.


Mitchell, Simon J., et al. "Cerebral arterial gas embolism by helium: an unusual case successfully treated with hyperbaric oxygen and lidocaine." Annals of emergency medicine 35.3 (2000): 300-303.


Chockalingam, Anand, et al. "Dynamic left ventricular outflow tract obstruction in acute myocardial infarction with shock cause, effect, and coincidence." Circulation116.5 (2007): e110-e113.