A Risk Score to Predict 30-Day Mortality in Patients with Intra-Aortic Balloon Pump Implantation

Abstract

Background: Several risk factors for early mortality after intra-aortic balloon pump (IABP) implantation have been described. Methods: We performed a retrospective analysis in 120 patients receiving peri- or postoperative IABP support. Univariate and multivariate analyses were carried out to assess variables potentially influencing 30-day mortality in order to develop a risk score for the prognosis of survival and for the decision on optimal patient-specific treatment. Results: The 4 parameters (mean arterial pressure, adrenaline dose, central venous pressure, and blood lactate concentrations) at 6 hours of IABP use were independently related to 30-day mortality. They were used to develop a risk score (0 - 4 points). With this score, patients who scored 3 or 4 points had no probability of surviving, whereas patients with a score of zero had a probability of 84.4 %. A prospectively screened cohort of 145 patients confirmed the reliability of our risk score. Conclusions: Our data demonstrate that a score can predict 30-day mortality in patients with IABP implantation. Such a score can be useful to find out whether or not ECMO/VAD implantation is necessary.

Key words

thoracic surgery - survival - risk score - intra‐aortic balloon pump

References

• 1 Vigneswaran W T, Reece I J, Davidson K G. Intra-aortic balloon pumping: seven years' experience.  Thorax. 1985;  40 858-861
• 2 Torchiana D F, Hirsch G, Buckley M J, Hahn C, Allyn J W, Akins C W, Drake J F, Newell J B, Austen W G. Intraaortic balloon pumping for cardiac support: trends in practice and outcome, 1968 to 1995.  J Thorac Cardiovasc Surg. 1997;  113 758-764
• 3 Baskett R J, O'Connor G T, Hirsch G M, Ghali W A, Sabadosa K, Morton J R, Ross C S, Hernandez F, Nugent W C, Lahey S J, Sisto D A, Dacey L J, Klemperer J D, Helm R E, Maitland A. A multicenter comparison of intraaortic balloon pump utilization in isolated coronary artery bypass graft surgery.  Ann Thorac Surg. 2003;  76 1988-1992
• 4 Ferguson J J, Cohen M, Freedman R J, Stone G W, Miller M F, Joseph D L, Ohman E M. The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry.  J Am Coll Cardiol. 2001;  38 1456-1462
• 5 Maccioli G, Lucas W, Norfleet E. The intra-aortic balloon pump: a review.  J Cardiothorac Anesth. 1988;  2 365-373
• 6 Baskett R JF, Ghali W A, Maitland A, Hirsch G M. The intraaortic balloon pump in cardiac surgery.  Ann Thorac Surg. 2002;  74 1276-1287
• 7 McGee M G, Zillgitt S, Trono R, Turner S A, Davis Uqua J M, Edelman S K, Norman J C. Retrospective analysis of the need for mechanical circulatory support (intra-aortic balloon pump/abdominal left ventricular assist device or partial artificial heart) after cardiopulmonary bypass.  Am J Cardiol. 1980;  46 135-142
• 8 Naunheim K S, Swartz M T, Pennington D G, Fiore A C, McBride L R, Peigh P S, Barnett M G, Vaca K J, Kaiser G C, Willman V L. Intraaortic balloon pumping in patients requiring cardiac operations. Risk analysis and long-term follow-up.  J Thorac Cardiovasc Surg. 1992;  104 1654-1660
• 9 Corral C H, Vaughn C C. Intraaortic balloon counterpulsation: an eleven-year review and analysis of determinants of survival.  Tex Heart Inst J. 1986;  13 39-44
• 10 Aksnes J, Abdelnoor M, Platou E S, Fjeld N B. Mortality in patients supported by intra-aortic balloon pump in the course of cardiac surgery was related to perioperative myocardial infarction.  Eur J Cardiothorac Surg. 1996;  10 408-411
• 11 Davies A R, Bellomo R, Raman J S, Gutteridge G A, Buxton B F. High lactate predicts the failure of intraaortic balloon pumping after cardiac surgery.  Ann Thorac Surg. 2001;  71 1415-1420
• 12 Hausmann H, Potapov E V, Koster A, Siniawski H, Kukucha M, Loebe M, Krabatsch T, Sodian R, Yeter R, Kuppe H, Hetzer R. Predictors of survival 1 hour after implantation of an intra-aortic balloon pump in cardiac surgery.  J Card Surg. 2001;  16 72-77
• 13 Hausmann H, Potapov E V, Koster A, Krabasch T, Stein J, Yeter R, Kukucka M, Sodian R, Kuppe H, Hetzer R. Prognosis after the implantation of an intra-aortic balloon pump in cardiac surgery calculated with a new score.  Circul. 2002;  (Suppl I) 106 I‐203-I‐211
• 14 Breisblatt W M, Stein K L, Wolfe C J, Follansbee W P, Capozzi J, Armitage J M, Hardesty R L. Acute myocardial dysfunction and recovery: a common occurrence after coronary bypass surgery.  J Am Coll Cardiol. 1990;  15 1261-1269
• 15 Baldwin R, Slogoff S, Noon G, Sekela M, Frazier O H, Edelman S K, Vaughn W K. A model to predict survival at time of postcardiotomy intraaortic balloon pump insertion.  Ann Thorac Surg. 1993;  53 908-913
• 16 El-Banayosy A, Cobaugh D, Zittermann A, Kitzner L, Arusoglu L, Morshuis M, Milting H, Tenderich G, Koerfer R. A multi-disciplinary network to save the lives of severe, persistent cardiogenic shock patients.  Ann Thorac Surg. 1005;  80 543-547
• 17 Creswell L L, Moulton M J, Cox J L, Rosenbloom M. Revascularization after acute myocardial infarction.  Ann Thorac Surg. 1995;  60 19-26
• 18 Ghali W A, Ash A S, Hall R E, Moskowitz M A. Variation in hospital rates of intraaortic balloon pump use in coronary artery bypass operations.  Ann Thorac Surg. 1999;  67 441-445