Escalation From Intra-Aortic Balloon Pump to Extracorporeal Membrane Oxygenation may be Associated With Poor Outcomes in Patients With Cardiogenic Shock - 22/04/26

Doi : 10.1016/j.hlc.2025.11.019

Liangshan Wang, MD ^a,^{^{1
Equal contribution as co-authors.}}, Kexin Wang, MD ^a,^{^{1
Equal contribution as co-authors.}}, Huiruo Liu, MD ^a,^{^{1
Equal contribution as co-authors.}}, Yan Wang, MD ^b, Gengchen Xu, BS ^a, Jin Li, MD ^a, Feng Yang, MD ^a, Chenglong Li, MD ^a, Haixiu Xie, MD ^a, Xing Hao, MD ^a, Hong Wang, MD, PhD ^a, Zhongtao Du, MD ^a,^⁎ , Xiaotong Hou, MD, PhD ^a,^⁎

^a Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, People's Republic of China

^b Queen's University, Kingston, ON, Canada

^∗ Corresponding authors at: Center for Cardiac Intensive Care, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, People's Republic of China Center for Cardiac Intensive Care Beijing Anzhen Hospital Capital Medical University Beijing 100029 People's Republic of China

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Abstract

Background & Aim

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) has been increasingly used for refractory cardiogenic shock (CS). Although guidelines have downgraded the recommendations for intra-aortic balloon pump (IABP) in CS, escalation from IABP to ECMO (IABP-ECMO) remains common in patients with CS. This study aims to determine the association between IABP-ECMO and outcomes for patients undergoing VA-ECMO.

Method

Adults who received IABP before VA-ECMO (IABP-ECMO group) or did not receive IABP before ECMO (direct ECMO group) from 1 January 2017, through 31 August 2022 were extracted from the Chinese Extracorporeal Life Support (CSECLS) registry. The primary outcome was in-hospital mortality.

Results

Among 4,607 patients meeting study inclusion, 655 (14.2%) received IABP before VA-ECMO. Patients in the IABP-ECMO group were older (age 61 vs 55 years), were more likely to have acute myocardial infarction (68.7% vs 39.1%), and were less likely to have cardiac arrest before ECMO (25.8% vs 41.4%) (all p<0.001). In-hospital mortality (57.1% vs 51.4 %; p=0.007) occurred more frequently in the IABP-ECMO group which persisted in multivariable modelling (adjusted odds ratio [aOR] 1,34; 95% confidence interval [CI] 1.08–1.67; p=0.008). Escalation from IABP to ECMO was also associated with on-support mortality (aOR 1.50; 95% CI 1.19–1.88; p=0.001) and limb ischaemia (adjusted OR 2.20; 95% CI 1.62–2.99; p<0.001).