Prophylactic intraaortic balloon counterpulsation in high-risk cardiac surgery: a survey of opinion and current practice.

INTRODUCTION: Patients undergoing cardiac surgery increasingly have greater comorbidities and subsequently are at higher risk of adverse postoperative outcomes. Despite some evidence suggests that prophylactic intraaortic balloon counterpulsation reduces mortality in selected high-risk patients, its use remains low. The aim of this study was to investigate reported management strategies of high-risk patients and attitudes towards further research in this area.

METHODS: A 22-question survey was developed and distributed electronically to all practicing cardiothoracic fellows through the email list of the Australian and New Zealand Society of Cardiac and Thoracic Surgeons.

RESULTS: The response rate was 28% (n=31). Reported use of prophylactic intraaortic balloon counterpulsation varied depending on the specified preoperative indication. Prophylactic intraaortic balloon counterpulsation was used occasionally or never by the majority of respondents for their patients with characteristics similar to those of previous trials. The most frequent reason given for not using prophylactic intraaortic balloon counterpulsation was lack of data (42.9%), with a willingness to consider participation in an randomised controlled trial of prophylactic intraaortic balloon counterpulsation by a large majority of respondents (79.3%).

CONCLUSIONS: The majority of surgeons who responded to this survey do not routinely use prophylactic intraaortic balloon counterpulsation for high-risk patients. Further prospective data is warranted to ascertain whether potential barriers to a randomised control trial of prophylactic intraaortic balloon counterpulsation, such as adequate patient numbers and clear selection criteria, can be overcome.