The Role of Intra-aortic Balloon Pump Therapy at Resource-Limited Institutions: A Bridge to Care Escalation

Despite providing relatively modest circulatory support, the intra-aortic balloon pump (IABP) remains the most utilized mechanical support device. IABP therapy specifically provides utility in transferring critically ill patients from resource-limited hospital settings. In a single-center series, 71 patients who received IABP were identified from 2018 to 2023. In this group, 66 (93%) patients presented with acute myocardial infarction (AMI), of which 40 (61%) patients presented with STEMI. Sixty-three (89%) patients presented in cardiogenic shock. In total, 15 (21%) patients died during their hospital stay. In-hospital death was found to be associated with higher age (p < 0.001), female sex (p = 0.004), and chronic heart failure (p = 0.009). Serologic markers of end-organ perfusion, such as lactate, creatinine, and hepatic enzymes, were associated with increased mortality risk. Thirty (41%) patients were successfully transferred to a hub institution for care escalation, including 17 (57%) patients receiving cardiac surgery, five (17%) receiving advanced PCI, and 12 (40%) receiving more robust mechanical support. Therefore, in the real-world setting, IABP therapy provides an accessible form of circulatory support at resource-limited institutions, especially when patient transfer is required within a larger hospital system.