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Effect of a Perioperative Intra-Aortic Balloon Pump in High-Risk Cardiac Surgery Patients: A Randomized Clinical Trial

2018; Lippincott Williams & Wilkins; Volume: 46; Issue: 8 Linguagem: Inglês

10.1097/ccm.0000000000003185

1530-0293

Graziela Santos Rocha Ferreira, Juliano Pinheiro de Almeida, Giovanni Landoni, Jean‐Louis Vincent, Evgeny Fominskiy, Filomena Regina Barbosa Gomes Galas, Fábio Antônio Gaiotto, Luís Alberto Oliveira Dallan, Rafael Alves Franco, Luiz Augusto Ferreira Lisboa, Luís Roberto Palma Dallan, Júlia Tizue Fukushima, Stéphanie Itala Rizk, Clarice Lee Park, Tânia Mara Varejão Strabelli, Silvia G. Lage, Lígia Câmara, S Zeferino, Jaquelline Maria Jardim, Elisandra Cristina Trevisan Calvo Arita, Juliana Caldas, Silvia Moreira Ayub‐Ferreira, José Otávio Costa Auler Júnior, Roberto Kalil Filho, Fábio Biscegli Jatene, Ludhmila Abrahão Hajjar,

Cardiac Ischemia and Reperfusion

The aim of this study was to evaluate the efficacy of perioperative intra-aortic balloon pump use in high-risk cardiac surgery patients.A single-center randomized controlled trial and a meta-analysis of randomized controlled trials.Heart Institute of São Paulo University.High-risk patients undergoing elective coronary artery bypass surgery.Patients were randomized to receive preskin incision intra-aortic balloon pump insertion after anesthesia induction versus no intra-aortic balloon pump use.The primary outcome was a composite endpoint of 30-day mortality and major morbidity (cardiogenic shock, stroke, acute renal failure, mediastinitis, prolonged mechanical ventilation, and a need for reoperation). A total of 181 patients (mean [SD] age 65.4 [9.4] yr; 32% female) were randomized. The primary outcome was observed in 43 patients (47.8%) in the intra-aortic balloon pump group and 42 patients (46.2%) in the control group (p = 0.46). The median duration of inotrope use (51 hr [interquartile range, 32-94 hr] vs 39 hr [interquartile range, 25-66 hr]; p = 0.007) and the ICU length of stay (5 d [interquartile range, 3-8 d] vs 4 d [interquartile range, 3-6 d]; p = 0.035) were longer in the intra-aortic balloon pump group than in the control group. A meta-analysis of 11 randomized controlled trials confirmed a lack of survival improvement in high-risk cardiac surgery patients with perioperative intra-aortic balloon pump use.In high-risk patients undergoing cardiac surgery, the perioperative use of an intra-aortic balloon pump did not reduce the occurrence of a composite outcome of 30-day mortality and major complications compared with usual care alone.