Letters To ‘Surfers: On The Relevancy of IABP Therapy…

Sig

Editor’s Note:

Was just going through some mail and stuff- and saw a few comments that I thought were interesting and would like to share.

Please respond in the comments section of this post…

Frank

20131030_104027=

Various questions on the relevancy of IABP Therapy

=

Hi Frank,
=
Rahul
=
My name is Rahul Barwal. I am a trained perfusionist from a Narayana Health Hospital in Bangalore, India.
=
=
Rahul
=
Currently I am working with Maquet Medical as clinical specialist for IABP as well as assistance in ECMO. My question to you is What is the role of IABP in these days where the other PLVAD’s have come like impella???
=
=
Rahul
=
No doubt IABP is still the most convenient therapy but the recent randomized trials like SHOCK II etc have changed the guidelines to class II b from class I b.
=

 

1 editor 2

Dear Rahul-

First of all- thank you for writing to ‘Surfers- and posing your question.

You have a good point questioning the efficacy and need for the IABP as a salvage or rescue therapy for LV dysfunction or treatment for  myocardial stunning.

During my tenure as a perfusionist, I definitely have observed a decrease in IABP utilization, probably due to improved interventional cardiac cath lab options, as well as improvement in intraoperative myocardial preservation during CPB.  Most often they are still an excellent prophylaxis for LM disease or LM equivalents (Cx, RCA, LAD).

I do feel that is is not obsolete and has it’s niche in our world.  I have always felt that afterload reduction was the true underlying benefit of diastolic counterpulsation devices.

I am not familiar with the class 1b or class 2b classification systems- can you please clarify?  As well, some insight into the SHOCK trials would very beneficial to those of us unfamiliar with them.

Any opinions out there?

Please leave them in the comments section of this post-

Thanks 🙂

Frank

Space 1

0 thoughts on “Letters To ‘Surfers: On The Relevancy of IABP Therapy…

  1. The IABP still remains one of the most effective methods of supporting the heart. Its greatest plus point is the ease of insertion without the need for access to the OR – it can be done at the bedside . Also it takes very little time to institute . Its action is immediate – cardiac output improves and PA pressures come down immediately . It has saved countless lives . The complication rate is very low if proper procedures are followed. About 15 years back we started using the sheathless technique and it has brought ischemic leg problems close to 0 .
    It continues to be the first line of therapy for ischemic failing hearts . In more severe cases the next option obviously will need to be activated .

  2. The SHOCK trial randomized patients in cardiogenic shock to balloon or no balloon. They saw no differences between the groups. IABP usage is still surgeon preference and in many places the surgeons only tool. I think the balloon makes the numbers look better, but not sure you’re gaining much more than a false sense of security. There are pharmacological ways to raise the Diastolic pressure and cardiac output.

  3. As a receiver of IABP therapy prior to my 4 banger, I can tell you my wife and the IRS are very happy I had an IABP.

Leave a Reply