Indications include:

• Cardiogenic shock secondary to acute coronary syndrome (ACS): the most common indication for IABP placement is after ACS, such as unstable angina refractory to medical therapies and STEMI with or without acute mitral regurgitation or ventricular septal defect.

• Postcardiotomy cardiogenic shock: postcardiac surgery where a patient is unable to be separated from cardiopulmonary bypass (CPB).

• Elective high-risk percutaneous coronary interventions (PCIs) in patients with LV dysfunction and extensive coronary artery disease (CAD) to maintain coronary perfusion and CO during the intervention.

• Symptomatic severe CAD (ie, high-grade left main disease) to increase coronary perfusion before intervention.

• High-risk cardiac patients presenting for urgent noncardiac surgical procedures.

Disadvantages include:

• The main disadvantage of the IABP is it provides limited hemodynamic support of 0.5 to 1.0 L/min.

• The effects of the IABP are less effective in patients with severe cardiogenic shock, and as a result, with the introduction of new cardiac assist devices, use of the IABP may decrease in the future.

References

• Heringlake M, Berggreen AE, Paarmann H. Still a place for aortic counterpulsation in cardiac surgery and patients with cardiogenic shock? Crit Care. 2021;25:309.
• Pilarczyk K, Boening A, Jakob H, et al. Preoperative intra-aortic counterpulsation in high-risk patients undergoing cardiac surgery: a meta-analysis of randomized controlled trials†. Eur J Cardiothorac Surg. 2016;49:5-17.
• Thiele H, Zeymer U, Neumann FJ, et al. Intraaortic balloon pump in cardiogenic shock II (IABP-SHOCK II) trial investigators. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12-month results of a randomized, open-label trial. Lancet. 2013;382:1638-1645.