The Role of Intra-aortic Balloon Pump Therapy at Resource-Limited Institutions: A Bridge to Care Escalation

TL;DR

This study shows that intra-aortic balloon pumps help stabilize critically ill patients at hospitals with limited resources, enabling their transfer to better-equipped facilities.

Contribution

The study demonstrates IABP's role as a bridge for transferring critically ill patients from resource-limited hospitals.

Findings

69% of patients with acute myocardial infarction and cardiogenic shock received IABP therapy.

41% of patients were successfully transferred to hub institutions for advanced care.

Higher age, female sex, and chronic heart failure were linked to in-hospital mortality.

Abstract

Despite providing relatively modest circulatory support, the intra-aortic balloon pump (IABP) remains the most utilized mechanical support device. IABP therapy specifically provides utility in transferring critically ill patients from resource-limited hospital settings. In a single-center series, 71 patients who received IABP were identified from 2018 to 2023. In this group, 66 (93%) patients presented with acute myocardial infarction (AMI), of which 40 (61%) patients presented with STEMI. Sixty-three (89%) patients presented in cardiogenic shock. In total, 15 (21%) patients died during their hospital stay. In-hospital death was found to be associated with higher age (p < 0.001), female sex (p = 0.004), and chronic heart failure (p = 0.009). Serologic markers of end-organ perfusion, such as lactate, creatinine, and hepatic enzymes, were associated with increased mortality risk. Thirty (41%) patients were successfully transferred to a hub institution for care escalation, including 17 (57%) patients receiving cardiac surgery, five (17%) receiving advanced PCI, and 12 (40%) receiving more robust mechanical support. Therefore, in the real-world setting, IABP therapy provides an accessible form of circulatory support at resource-limited institutions, especially when patient transfer is required within a larger hospital system.

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