Alberto Zangrillo, Federico Pappalardo, Roberto Dossi, Ambra Di Prima, Marta Sassone, Teresa Greco, Fabrizio Monaco, Mario Musu, Gabriele Finco, Giovanni Landoni Critical Care 2015, 19:10 (14 January 2015)
Introduction: The intra-aortic balloon pump is routinely used in cardiac surgery; however its impact on outcome is yet matter of debate and randomized trials were recently published. We perform an updated meta-analysis of randomized controlled trials that investigated the use of preoperative intra-aortic balloon pump in adult patients undergoing coronary artery bypass grafting.
Methods: Potentially eligible trials were identified by searching the Medline, Embase, Scopus, ISI Web of Knowledge and The Cochrane Library. Searches were not restricted by language or publication status and were updated in August 2014. Randomised controlled trials on preoperative intra-aortic balloon pump in patients undergoing coronary artery bypass grafting either with or without cardiopulmonary bypass were identified. The primary endpoint was mortality at the longest follow up available and the secondary endpoint was 30-days mortality.
Results: The eight included randomized clinical trials enrolled 625 patients (312 to intra-aortic balloon pump group and 313 to control). The use of intra-aortic balloon pump was associated with a significant reduction in the risk of mortality (11 of 312 (3.5%) versus 33 of 313 (11%), risk ratio?=?0.38 (0.20 to 0.73), P for effect?=?0.004, P for heterogeneity?=?0.7, I-square?=?0%, with eight studies included). The benefit on mortality reduction was confirmed restricting the analysis to trials with low risk of bias, to those reporting 30-days follow up and to patients undergoing coronary artery bypass graft surgery with cardiopulmonary bypass.
Conclusions: Preoperative intra-aortic balloon pump reduces perioperative and 30-days mortality in high-risk patients undergoing elective coronary artery bypass grafting.
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