Primary intra-aortic balloon support versus inotropes for decompensated heart failure and low output: a randomised trial

Aims: The haemodynamic effects of primary implantation of an intra-aortic balloon pump (IABP) versus inotropes in decompensated heart failure and low output (DHF-LO), but without an acute coronary syndrome, have not been investigated. We therefore aimed to investigate the effect of primary IABP implantation as compared to inotropes on haemodynamics in DHF-LO with no acute ischaemia. Methods and results: Patients (n=32) with DHF-LO despite IV diuretics were randomised to primary 50 mL IABP or inotropes (INO: enoximone or dobutamine). The primary endpoint was the improvement RI RUJDQ SHUIXVLRQ DVVHVVHG E\ ¨ PL[HGYHQRXV R[\JHQ VDWXUDWLRQ 6Y22 ) at 3 hours; secondary endpoints LQFOXGHG¨FDUGLDFSRZHURXWSXW&3217SUR%13SURSRUWLRQDOFKDQJHFXPXODWLYHIOXLGEDODQFHDQG¨G\Vpnoea severity score, all at 48 hours. Data are presented as median (IQR). Patients were 60 (48-69) years old and 72% were male. Baseline SvO2 ZDV¨6Y22 was higher in the IABP group (+17 [+9; +24] vs >@S,$%3SDWLHQWVKDGDKLJKHU¨&32DJUHDWHUUHODWLYHUHGXFWLRQLQ17SUR%13DPRUH negative cumulative fluid balance, and a greater reduction in dyspnoea severity score. There were no IABPrelated serious adverse events (SAEs). Thirty-day mortality was 23% (IABP) vs 44% (INO). Conclusions: Primary circulatory support by IABP showed a significant increase in improved organ perfusion assessed by SvO2.

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