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Intra-aortic Balloon Pump Placement at the Bedside: A Single-Center Experience of CICU versus CathLab Insertion, Management, and Removal.
Session:
Comunicações Orais - Sessão 14 - Choque cardiogénico e suporte circulatório mecânico
Speaker:
Rita Almeida Carvalho
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.4 Acute Cardiac Care – Cardiogenic Shock
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Rita Almeida Carvalho; Mariana Sousa Paiva; Débora Correia; Rita Barbosa Sousa; Samuel Azevedo; Joana Certo Pereira; Miguel Domingues; Ana Rita Bello; João Presume; Catarina Brízido; Christopher Strong; António Tralhão
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Background:</strong> The intra-aortic balloon pump (IABP) is frequently used to support patients with hemodynamic instability in the Cardiac Intensive Care Unit (CICU). Despite being classically implanted at the catheterization laboratory (CathLab) under fluoroscopic guidance, its easy implantation technique may allow rapid deployment at the bedside.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Aim:</strong> The aim of this study was to assess the feasibility and safety of bedside IABP insertion in the CICU using a standardized technique based on anatomic landmarks, as compared to the fluoroscopic-guided IABP insertion at the CathLab.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Retrospective single-center study of consecutive patients with cardiogenic shock (CS) admitted to a CICU between January 2019 and October 2023, who received transfemoral IABP for hemodynamic support or left ventricular unloading. The overall study cohort was divided according to the IABP implantation strategy into CICU and CathLab groups. The chosen approach, timing and removal strategy were at the discretion of the treating physician. IABP insertion in the CICU was performed using echo-guided arterial puncture, subsequent device deployment according to anatomic landmarks, and final position confirmation by chest x-ray. The efficacy endpoint was successful IABP deployment according to the first chosen approach, while safety endpoints were short-term IABP-related vascular complications. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> A total of 53 patients were included (mean age 64 ± 14 years; 70% males; 74% acute myocardial infarction (AMI); 93% SCAI C). Seventeen (32%) patients received an IABP at the bedside in the CICU, and all were deployed effectively with no need for CathLab transfer. The CICU cohort featured a lower proportion of AMI-CS patients (47% vs 86%; p=0.003), but a higher proportion of concomitant mechanical circulatory support with VA-ECMO (65% vs 22%; p=0.003). Duration of IABP support was longer in the CICU group (6.9 ± 4.3 vs. 3.6 ± 3.4 days; p=0.004). IABP removal was mostly done by manual compression (91%) followed by the use of a vascular closure device (6%), with no differences between groups. Bedside IABP implantation did not significantly impact on the number of short-term vascular complications, namely IABP-site-related or other major (BARC 3 to 5) bleeding (4 vs 2; p=0.127) or ischemic events (5 vs 7; p=0.211), such as IABP limb ischemia, stroke or intestinal ischemia. Although vascular complications in both groups were more common in patients simultaneously on VA-ECMO, the frequency of IABP limb-related events was not different between implantation strategies. No pseudo-aneurysms, fistulas or arterial dissections were identified in both groups.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong> Bedside IABP insertion using anatomic landmarks is a feasible and safe approach in patients in CS requiring IABP support. These CICU skills improve CS management, particularly in non-AMI-CS and very unstable patients, avoiding the need for CathLab transfer.</span></span></p>
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