Indications. Intra-aortic balloon counterpulsation is
indicated in patients to provide circulatory support;
• until a surgical defect (e.g. ventricular septal defect,
ruptured papillary muscle) has been corrected, or
until the patient has received a cardiac transplant,
78
• in the cardiothoracic surgical patient when weaning
from cardiopulmonary bypass has been difficult,
• in patients with refractory angina before coronary
artery surgery is performed, and
• in patients with reversible cardiogenic shock (e.g.
anaphylactic, local anaesthetic, quinidine or
antihistamine toxicity79).
While the use of these devices has not
significantly increased survival in patients with
ischaemia-induced cardiogenic shock in the absence
of revascularisation procedures (e.g. PTCA or
coronary artery stenting),
80,81 in a review of patients
with cardiogenic shock treated with thrombolytic
therapy, early use of IABP was associated with a
trend toward lower 30-day and 1-year all-cause
mortality.
82 The use of IABP has also been
associated with a reduction in coronary artery
reocclusion and cardiac events after angioplasty for
acute myocardial infarction