Concomitant Intra-Aortic Balloon Pump Use in Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

Saraschandra Vallabhajosyula, John C. O'Horo, Phanindra Antharam, Sindhura Ananthaneni, Saarwaani Vallabhajosyula, John M. Stulak, Mackram Eleid, Shannon M Dunlay, Bernard J. Gersh, Charanjit Rihal, Gregory W. Barsness

Research output: Contribution to journalArticlepeer-review

45 Scopus citations


BACKGROUND: There are contrasting reports on the effectiveness of a concomitant intra-aortic balloon pump (IABP) in cardiogenic shock patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This study sought to compare short-term mortality in patients with cardiogenic shock treated with VA-ECMO with and without IABP.

METHODS AND RESULTS: We reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring VA-ECMO for cardiogenic shock with concomitant IABP. Studies reporting short-term mortality were included. Meta-analysis of the association of IABP with mortality was performed using Mantel-Haenszel models. Subgroup analyses were performed in patients with cardiogenic shock complicating acute myocardial infarction (AMI) and postcardiotomy cardiogenic shock. Twenty-two observational studies with 4653 patients were included. These studies showed high heterogeneity for the total and postcardiotomy cardiogenic shock cohorts and low heterogeneity for the AMI cohort. Short-term mortality was not significantly different in patients with and without IABP 42.1% versus 57.8%; risk ratio, 0.80; 95% CI, 0.52-1.22; P=0.30. However, concomitant IABP with VA-ECMO was associated with lower mortality in patients with AMI (50.8% versus 62.4%; risk ratio, 0.56; 95% CI, 0.46-0.67; P<0.001). There was no difference in mortality in postcardiotomy cardiogenic shock and mixed causes for cardiogenic shock.

CONCLUSIONS: In cardiogenic shock patients requiring VA-ECMO support, the use of IABP did not influence mortality in the total cohort. In patients with AMI, use of IABP with VA-ECMO was associated with 18.5% lower mortality in comparison to patients on VA-ECMO alone. Further randomized studies are warranted to corroborate these observational data.

Original languageEnglish (US)
Pages (from-to)e006930
JournalCirculation. Cardiovascular interventions
Issue number9
StatePublished - Sep 1 2018


  • extracorporeal membrane oxygenation
  • intra-aortic balloon pumping
  • myocardial infarction
  • patients
  • risk

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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