| Abstract [eng] |
SUMMARY Relevance of the problem. Cardiogenic shock develops in 2–6% of patients undergoing cardiac surgery, and the risk of death due to post-cardiotomy cardiogenic shock is as high as 50–80%. Intra-aortic balloon counterpulsation has been used for many years for the management of cardiogenic shock and has shown good results. However, the SHOCK II trial, which was conducted before 2012, raised doubts about the effectiveness of this device. The high mortality due to cardiogenic shock and the controversial results of intra-aortic balloon counterpulsation suggest that the effectiveness of this device in the management of cardiogenic shock in cardiac surgery patients merits further investigation. Aim of the work. To review the scientific literature and assess whether intra-aortic balloon counterpulsation in cardiac surgery is effective and advisable. Material and methods. A literature search was performed on the PubMed database using the following keywords: intraaortic balloon pump, IABP, counterpulsation, cardiac surgery, postcardiotomy, cardiogenic shock. Full-text articles in English published between 2014 and 2024 were selected. Results. Intra-aortic balloon counterpulsation is not routinely allowed in interventional cardiology. It is only effective here in the case of failed percutaneous coronary intervention. However, intra-aortic balloon counterpulsation is effective in cardiac surgery, both in coronary artery bypass grafting and in heart transplantation. It has been associated with lower short- and long-term mortality after cardiac surgery, shorter hospitalisation, and a lower incidence of certain post-operative complications. Prophylactic counterpulsation was found to be more effective than emergency counterpulsation and was associated with fewer complications. If prophylactic counterpulsation has not been used, it should not be delayed after the onset of cardiogenic shock, as earlier counterpulsation is associated with greater efficacy. Intra-aortic balloon counterpulsation can be used as a bridge to transplantation, stabilising hemodynamics before transplantation and increasing survival after surgery. Conclusions. Intra-aortic balloon counterpulsation is not recommended in interventional cardiology but is effective and should be used in cardiac surgery for high-risk patients. The earlier the onset of counterpulsation after cardiogenic shock begins, the better the outcome. Keywords: cardiac surgery, cardiogenic shock, intra-aortic balloon pump. |
