Intra-Aortic Balloon Pump Counterpulsation in the Post-Resuscitation Period is Associated with Improved Functional Outcomes in Patients Surviving an Out-of-Hospital Cardiac Arrest: Insights from a Dedicated Heart Attack Centre

详细信息    查看全文

• 作者：M. Bilal Iqbal ; MD^a ; ^{b.iqbal@imperial.ac.uk" class="auth_mail" title="E-mail the corresponding author} ; ^{biqbal@excite.com" class="auth_mail" title="E-mail the corresponding author} ; Abtehale Al-Hussaini ; MD^a ; Gareth Rosser ; MD^a ; Ramyah Rajakulasingam ; MD^a ; Jayna Patel ; MD^a ; Katharine Elliott ; MD^a ; Poornima Mohan ; MD^a ; Maria Phylactou ; MD^a ; Rebecca Green ; MD^a ; Mark Whitbread ; MSc^b ; Mark Mason ; MD^a ; ^b ; Richard Grocott-Mason ; MD^a ; ^b ; Robert Smith ; MD^a ; Charles Ilsley ; MD^a
• 关键词：Out-of-hospital cardiac arrest ; Intra-aortic balloon pump ; Functional survival
• 刊名：Heart, Lung and Circulation
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：25
• 期：12
• 页码：1210-1217
• 全文大小：483 K

文摘

Despite advances in cardiopulmonary resuscitation, functional survival remains low after out-of-hospital cardiac arrest (OOHCA). Intra-aortic balloon pump (IABP) therapy has recently been shown to augment cerebral blood flow. Whether IABP therapy in the post-resuscitation period improves functional outcomes is unknown.

Methods

We analysed 174 consecutive patients who were successfully resuscitated from an OOHCA between 2011-2013 at Harefield Hospital, London. We analysed functional status at discharge and mortality up to one year.

Results

A total of 55 patients (32.1%) received IABP therapy. Comparing those receiving IABP with those not receiving IABP, there was no difference in favourable functional status at discharge (49.1% vs. 57.1%, p=0.321); and mortality at one year (45.5% vs. 35.5%, p=0.164). Multivariable analyses identified IABP therapy as a strong independent predictor for favourable functional status at discharge (OR=7.51, 95% CI: 2.15-26.14, p=0.002) and this association was maintained in propensity-score adjusted analyses (OR=9.90, 95% CI: 2.11-46.33, p=0.004) and inverse probability treatment weighted analyses (OR=10.84, 95% CI: 2.75-42.69, p<0.001). However, IABP therapy was not an independent predictor for mortality at one year (HR=0.93, 95% CI: 0.52-1.65, p=0.810) and this was confirmed in both propensity-score adjusted and inverse probability treatment weighted analyses.

Conclusions

In this observational analysis of patients surviving an OOHCA, the use of IABP therapy in the post-resuscitation period was associated with improved functional outcomes. This warrants further evaluation in larger prospective studies.