Use of intra-aortic balloon pump in cardiac surgical patients; the Cleveland Clinic experience, 1975–1976

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The intra-aortic balloon pump (IABP) has become a widely accepted means of managing patients with unstable cardiac perfusion and poor left ventricular function.1–7 Originally applied to patients with cardiogenic shock secondary to myocardial infarction, the IABP has more recently been used in a variety of clinical states that cause poor cardiac function. Our experience with IABP support has been limited almost entirely to patients who cannot be weaned from cardiopulmonary bypass or to those who experience severe circulatory failure in the immediate postoperative period.

The criteria for use of IABP in this series were refractory left ventricular failure unresponsive to manipulation of blood volume, cardiotonic drugs, and catecholamines and occurring either as an intraoperative event following the withdrawal of cardiopulmonary bypass or as a postoperative complication. Cardiac function in all patients was monitored routinely by direct assessment of left atrial, central venous and mean atrial pressures, and determination of cardiac output (CO) by thermodilution. Progressive elevation of left atrial and central venous pressures with declining arterial pressure and CO, despite full pharmacologic support, identified the candidate for IABP support. When low cardiac output could not be reversed or stabilized pharmacologically, IABP support was instituted.

Clinical material

From April 1975 to April 1976, the Datascope System 80 was used in 33 patients aged 31 to 71 years. Twenty-eight of the 33 had significant coronary artery disease. Support by extracorporeal perfusion and IABP was unsuccessful in five patients who died in the operating room; insertion and support by IABP were successful. . .



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