Clinical experience with intraaortic balloon pump support in 728 patients.

From November, 1968, through December, 1976, intraaortic balloon pump (IABP) circulatory support was used 747 times in 728 patients. Overall in-hospital survival was 413/747 (56.9%). Survival with IABP since 1974 has been 65% (286/440) compared to 24% (18/75) in 1968-1971 (P < 0.001). Two practical changes have been associated with this improvement: 1) broadened indications for, and earlier insertion of, IABP; and 2) more aggressive surgical treatment of the primary cardiac lesion. Cardiogenic shock or chronic ischemic ventricular failure accounted for 78.7% (59/75) of IABP in 1968-1971; during 1974-1976 only 26.4% (116/440) of IABP-supported patients were in these categories (P < 0.001). Since 1974, 58.2% (153/263) of IABP patients had an operative procedure following IABP insertion compared to 37.7% (23/611 prior to 1971 (P < 0.01). The major complication rate has remained unchanged at 8.5%. IABP-related mortality rate was 0.8% (6/728). Earlier, more liberal, use of IABP hemodynamic support has led to increased survival in a large number of patients with complications of acute myocardial ischemia. The low mortality associated with its use vindicates earlier institution of IABP support in cardiogenic shock.