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Quantitative Indices of Intra‐Aortic Balloon Pump (IABP) Dependence During Post‐Infarction Cardiogenic Shock
Author(s) -
Sturm James T.,
Fuhrman Thomas M.,
Igo Stephen R.,
Holub Daniel A.,
McGee Michael G.,
Fuqua John M.,
Norman John C.
Publication year - 1980
Publication title -
artificial organs
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.684
H-Index - 76
eISSN - 1525-1594
pISSN - 0160-564X
DOI - 10.1111/j.1525-1594.1980.tb03892.x
Subject(s) - cardiogenic shock , intra aortic balloon pump , medicine , cardiology , intra aortic balloon pumping , myocardial infarction , hemodynamics , shock (circulatory) , balloon , cardiac index , cardiac output
In an attempt to quantitate intra‐aortic balloon pump (IABP) dependence and differentiate retrievable post‐infarction cardiogenic shock situations, thirty‐five patients were analyzed in regard to age, duration of IABP support, and hemodynamic performance. Survivors were younger than non‐survivors (P<0.01) and the duration of IABP support in survivors was greater than that of non‐survivors (P<0.05). When duration of IABP support was plotted against age, three zones of increasing dependence and mortality were apparent. In Zone 1 (ages 32–40), there was no dependence or mortality; in Zone 2 (ages 40–65, IABP durations < 250 hours), there were several instances of dependence and a 63% mortality; in Zone 3 (ages gt; 65 or IABP durations > 250 hours), there was a 100% mortality. IABP dependence was best recognized by time‐course trajectory plots of cardiac index versus systemic vascular resistance. Three trends were observed. All patients who improved to Class A (CIgt; 2.1 L/min/m 2 , SVR< 2100 dynes sec cm ‐5 ) survived unless they succumbed to sudden ventricular dysrhythmias. Patients who remained in Class B (1.2 L/min/m 2 < CI< 2.1 L/min/m 2 , with SVR's < 2100 dynes sec cm ‐5 ) for 7–14 days were IABP‐dependent and eventually expired. Patients who deteriorated to or remained in Class C (CI< 1.2 L/min/m 2 or SVR> 2100 dynes sec cm ‐5 ) expired early despite IABP support and were considered irretrievable. This study suggests that post‐infarction cardiogenic shock IABP‐dependence can be quantitated to a certain degree. Post‐infarction IABP‐dependent patients are relatively young (40–55), do not expire during the first 50 hours of IABP support, neither improve nor deteriorate during the second 50 hours of support, and remain in Class B for 7–10 days without the occurrence of life‐threatening ventricular dysrhythmias. In such situations, sufficient time may be available for cardiac catheterization to determine the appropriateness of subsequent operative interventions.