(804) Predictors of Poor Early Hemodyamic Response to Intra-Aortic Balloon Pump

• Published in: The Journal of heart and lung transplantation Vol. 42; no. 4; pp. S352 - S353
• Main Authors: Castagna, F., Chalhoub, G., Ippolito, P., 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.2023.02.817

Lack of early response to temporary mechanical circulatory support (tMCS) is a critical condition that requires rapid identification and a prompt escalation of care with more invasive forms of tMCS. Today, intra-aortic balloon pump (IABP) remains the most utilized form of tMCS, but prediction of its early effect is still poorly understood. Aim of this study was to identify the patients where the IABP did not produce an increase in cardiac output (CO) in the first 24h post insertion.
In this single-center retrospective analysis, we enrolled all the patients in cardiogenic shock (defined as SBP <90mmHg OR on pressors OR with cardiac index <2.2 l/m/m2 and wedge >15mmHg) who received an IABP between February 2016 - August 2022. Patients without a baseline CO assessment and/or without a CO assessment in the first 24h post IABP were excluded. Similarly, patients without hemodynamic data from a right heart catheterization before IABP insertion were excluded. We defined non-responders the patients in which CO did not increase in the first 24h post IABP. Stepwise backward logistic regression models were utilized to identify the variable associated with the lack of early response.
114 patients (age 62±14y, 66% male, 54% ICM, 42% presenting with ACS, baseline CO 3.3 ± 0.9 l/min, CI 1.7±0.4 l/min/m2, baseline SBP 109±19 mmHg, 40% on inotropes at the moment of IABP insertion) were included in the analysis. On average, CO increased by 1.2± 1.3 l/min in the first 24h. CO did not increase in 17 (15%) patients. In the multivariable analysis, ejection fraction (EF), female gender, and CO before IABP were independently associated with the risk of no early response (ROC area = 0.82). Higher EF had protective effect (OR 0.93 CI 0.87-0.99), while female gender (OR 5.80 CI 1.39 - 24.19), and CO value before IABP (OR 5.7 CI 2.34 - 13.75) were associated with a higher chance of lack of early response.
Female patients and patients with a reduced EF have a higher chance to exhibit a lack of early increase in CO after IABP insertion. Similarly, attenuated early improvement of CO is likely to be observed in patients who already have a high CO before the IABP insertion.