(803) Early Adverse Events Post-Iabp Discontinuation are Reduced with a Rapid Daily Structured Iabp Assessment

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; p. S352
• Main Authors: Castagna, F., Ippolito, P., Chalhoub, G., Saeed, O., Sims, D., Jorde, U.
• Format: Journal Article
• Language: English
• Published: Elsevier Inc 01-04-2023
• ISSN: 1053-2498; 1557-3117
• DOI: 10.1016/j.healun.2023.02.816

Identification of the correct timing to discontinue intra-aortic balloon pump (IABP) is challenging. Several protocols have been proposed to assess the pt readiness to be weaned from the device, but their duration (tens of minutes to hours) significantly reduces their utilization.
In October 2021, we instituted a rapid daily assessment for all pts supported by IABP. During the assessment, IABP inflation frequency is gradually reduced over the course of 3 minutes, while changes in hemodynamic parameters are monitored (Figure). Aim of the current study was to assess if the utilization of a rapid daily IABP assessment reduces the frequency of early post-IABP discontinuation adverse events.
We included all the IABP pts (n=463) in which the device was removed from Feb 2016 to Aug 2022. Cohort was divided in pre-protocol (implanted between Feb 2016 and September 2021) and post protocol (implanted between October 2021 and August 2022). We excluded pts where the IABP was utilized only as support during interventional cardiology procedures, pts who died while on IABP before it was removed, and pts where IABP was discontinued as palliative measure. We defined adverse event the death in the 24h post IABP discontinuation or the emergency placement of IABP/ECMO/impella in the 24h post IABP discontinuation.
372 pts received an IABP in the pre-protocol era and 91 in the post protocol era. No differences in age (62±13 vs 64±14y, p=0.42), male sex (65 vs 64%, P=0.81), presence of ACS (54.6 vs 55.0%, p=0.95), duration of support (2.33 [1.47-4.08] vs 1.99 [1.42-3.95] days, p=0.49) were noted among the two groups. Cardiac index was lower in the post-protocol group (2.07±0.62 vs 1.84±0.59 l/m2, p=0.009). 16 (4.3%) vs 0 (0%), p=0.028, pts experienced an adverse event in the pre-protocol vs the protocol era, respectively.
Assessment of IABP hemodynamics with a rapid daily structured protocol is associated with a reduction of early adverse events post-IABP discontinuation.