Experiences with the intra aortic counterpulsing balloon in cardiogenic shock

87 Patients who met the criteria for definite myocardial infarction and refractory cardiogenic shock treated with the intra aortic balloon pump are discussed. Of the 87 patients, 66 (76%) were male, and 37 (42%) had a prior history of angina pectoris, 22 (25%) had prior myocardial infarction, 14 (16%) past congestive heart failure and 14 (16%) a history of hypertension. The mean age was 61 yr. The median time from the clinical onset of acute myocardial infarction to the development of cardiogenic shock was 13 hr. Balloon assistance was begun at median of 9 hr after the onset of shock. Support of the circulation was continued at median of 17 hr. The hemodynamic effects of intraaortic balloon counterpulsation are presented. The clinical effects of balloon counterpulsation were often impressive. Oliguria and acidemia were reversed in 70% and 69%, respectively, of the patients who had the abnormality prior to treatment. With the use of the balloon it was possible to discontinue pressor drugs in almost two thirds of the subjects. On the other hand, pulmonary congestion and abnormalities of mental status were reversible in less than half of the patients. 52 Patients could not be 'weaned' from the balloon while 35 survived discontinuation of assistance. Of the 35 survivors, 15 left the hospital, 10 are still alive and 8 have lived more than 1 yr after discontinuation of assistance.