Fuernau G, Thiele H.; Curr Opin Crit Care. 2013 Oct;19(5):404-9.

Purpose of review: Despite developments in treatment of myocardial infarction, mortality rates in cardiogenic shock remain unacceptably high. Intra-aortic balloon pumping (IABP) is to date the most used device for hemodynamic support, but randomized evidence on survival benefit was lacking.

Recent findings: A recently published meta-analysis with hints for higher mortality after primary percutaneous intervention challenged the previous high-grade recommendations for IABP. Therefore the use in cardiogenic shock was downgraded in the last versions of European and American guidelines from a class I to a class IIa and IIb recommendation, respectively. Furthermore, a large scale randomized trial found no benefit on 30-day mortality in patients with myocardial infarction complicated by cardiogenic shock. This result was supported by a lack of difference in all subgroups and secondary endpoints.

Summary: In cardiogenic shock, no general recommendation for IABP can be given. In the next revision of current guidelines, recent randomized trial results should be incorporated. Further research is needed to develop optional treatments in cardiogenic shock or to gain validated algorithms for use of active assist devices.

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