I watched with high interest the webcast from the last ESC congress http://spo.escardio.org/SessionDetails.aspx?id=398931#.UEiARUSHdRA and also read the paper on the NEJM (Pubmed ID 22920912). After a careful analysis of those data I think it is NOT the time to exclude IABP from the treatment of cardiogenic shock; also the trial, although well designed, has some limitation as also some very important details are overlooked.
I'd like to hear your thoughts about it.
It is interesting to note that serum lactate level did not have any impact. The message was clear (in my mind) that IABP benefit should be looked in parallel with "immediate/urgent" revascularization, not as an temporary mechanical (i.e. non-pharmacological) support. Cost-benefit assessment would also be interesting to know.
Although the SHOCK II Trial was a well designed one some questions still coming up. In discussion at the ESC congress Dr. Hoppe mentioned wether timing of IABP-Implantation may have a certain effect on outcome. As we know the region of myocardial necrosis is growing every minute during MI. In some cases i would suggest a better coronary perfusion done by IABP is faster achieved than a definitive stenting. And what about severe mitral regurgitation ? Seen too many patients with severe MI recompensating after IABP -Implantation by reducing the afterload. So in my mind there is no good reason to ban IABPs from ICUs or cath labs.
Sorry for the late comments, but I just saw that question right now:
IABP was used as mechanical support in cardiogenic shock in patients with contemporary care including early revascularisation.
For timing of IABP implantation no differences were seen for insertion before or after PCI. Furthermore in STEMI without shock no benefit has been found with early IABP insertion in the CRISP-AMI trial (http://www.ncbi.nlm.nih.gov/pubmed/21878431).
Mechanical complications before randomization (e.g. severe MR because of papillary muscle rupture or ventricular septal defects) were part of exclusion criteria. Thus, no no recommendation can be made for this cases.
- Badges
- Science topic
- Similar topics
- Biological Science
- Physiology
- Physiological Processes
- Stress