293 * EXTRACORPOREAL LIFE SUPPORT FOR CARDIOGENIC SHOCK: INFLUENCE OF CONCOMITANT INTRA-AORTIC BALLOON COUNTERPULSATION

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Objectives: Intra-aortic balloon counterpulsation (IABP) during extracorporeal life support (ECLS) for cardiogenic shock may improve pulsatility and coronary perfusion and thereby promote recovery of cardiac function. However, the risks and benefits of IABP during ECLS in real clinical settings have not been evaluated. This study aims to evaluate the effect of IABP on the early outcome of ECLS for cardiogenic shock. Methods: We evaluated 253 adult patients (aged 58.8 ± 15.3 years, 154 males) undergoing ECLS for cardiogenic shock from January 2005 to August 2012. Of them, 60 patients underwent concomitant IABP (IABP group) whereas 193 patients underwent ECLS only (control group). In-hospital outcomes were compared using the inverse probability of treatment weighting model based on propensity scores. Results: The indications for ECLS were low cardiac output after cardiac surgery in 118 patients (46.6%), heart failure in 71 (28.1%), acute myocardial infarction in 49 (19.4%) and other indications in 15 (5.9%). The successful ECLS weaning rate was significantly higher in the IABP group than the control group (61.7% vs 42.0%, P = 0.008); however, there was no significant difference in in-hospital mortality between the two groups (68.6% vs 72.0%, P = 0.58). After adjustment for baseline characteristics, the IABP group showed a decreased risk of weaning failure (HR 0.51; 95% CI 0.28-0.92, P = 0.024) but with a similar risk of in-hospital mortality (HR 0.85; 95% CI 0.46-1.60; P = 0.62) compared with the control group. Conclusions: The use of IABP during ECLS increased successful ECLS weaning rate, but was not translated to improved survival. Studies on larger populations may verify the survival effect of IABP during ECLS.

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