Intra-aortic Balloon Pump vs Peripheral Ventricular Assist Device Utilization in the US.

Abstract Background The objective of the present study was to characterize practical utilization trends and outcomes for intra-aortic balloon pump (IABP) and percutaneous left ventricular assist device (pVAD) in cardiogenic shock at a national level. Methods An analysis of all adult patients admitted non-electively for cardiogenic shock from January 2008 through December 2017 was performed using the National Inpatient Sample (NIS). Trends of inpatient IABP and pVAD use were analyzed using survey weighted estimates and the modified Cochran-Armitage test for significance. Multivariable regression models and inverse probability of treatment weights (IPTW) were used to perform risk-adjusted analyses of pVAD mortality a composite of adverse events (AE), and resource utilization, with IABP as reference. Results Of an estimated 774,310 patients admitted with cardiogenic shock, 143,051received a device: IABP=127,792 (16.5%) or pVAD=15,259 (2.0%). The usage of IABP decreased (23.8 to 12.7%, p-for-trend Conclusions Over the study period, the rate of pVAD utilization for cardiogenic shock has significantly increased. Compared to IABP, pVAD use was associated with increased mortality, costs and several adverse events. Multi-institutional clinical trials with rigorous inclusion criteria are warranted to evaluate the clinical utility of pVADs in the modern era.