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Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial

par Rocha Ferreira, Graziela Santos;de Almeida, J.P.;Landoni, Giovanni;Vincent, Jean Louis ;Fominskiy, Evgeny;Gomes Galas, Filomena Regina Barbosa;Gaiotto, Fábio Antônio;Dallan, Luis Oliveira;Franco, Rafael Alves;Lisboa, Luiz Augusto;Palma Dallan, Luis Roberto;Fukushima, Julia J.T.;Rizk, Stéphanie Itala;Park, Clarice Lee;Strabelli, Tânia Mara;Gelas Lage, Silvia Helena;Camara, Ligia;Zeferino, Suely;Jardim, Jaquelline;Calvo Arita, Elisandra Cristina Trevisan;Caldas Ribeiro, Juliana;Ayub-Ferreira, Silvia Moreira;Costa Auler, Jose Otavio;Filho, Roberto Kalil;Jatene, Fabio Biscegli;Hajjar, Ludhmila Abrahão
Référence Critical care medicine, 46, 8, page (e742-e750)
Publication Publié, 2018-08

Article révisé par les pairs

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Résumé :

OBJECTIVES: The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients. DESIGN: A single-center randomized controlled trial and a meta-analysis of randomized controlled trials. SETTING: Heart Institute of São Paulo University. PATIENTS: High-risk patients undergoing elective coronary artery bypass surgery. INTERVENTION: Patients were randomized to receive preskin incision intra-aortic balloon pump insertion after anesthesia induction versus no intra-aortic balloon pump use. MEASUREMENTS AND MAIN RESULTS: The primary outcome was a composite endpoint of 30-day mortality and major morbidity (cardiogenic shock, stroke, acute renal failure, mediastinitis, prolonged mechanical ventilation, and a need for reoperation). A total of 181 patients (mean [SD] age 65.4 [9.4] yr; 32% female) were randomized. The primary outcome was observed in 43 patients (47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in the control group (p = 0.46). The median duration of inotrope use (51 hr [interquartile range, 32-94 hr] vs 39 hr [interquartile range, 25-66 hr]; p = 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4 d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic balloon pump group than in the control group. A meta-analysis of 11 randomized controlled trials confirmed a lack of survival improvement in high-risk cardiac surgery patients with perioperative intra-aortic balloon pump use. CONCLUSIONS: In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.