Australasian trends in intra-aortic balloon counterpulsation weaning: results of a postal survey
ABSTRACT
Objective: To generate baseline data describingAustralasian intra-aortic balloon counterpulsation (IABP)weaning practice.
Methods: A five-part questionnaire was mailed in April 2005 to all 192 intensive care units in Australia and New Zealand.
Results: 116 ICUs responded (response rate, 60%), and 54reported using IABP. Most of the 54 were in hospitals whichwere public government-funded (65%), had between 100and 500 beds (69%), and treated a minimum of 11 patientsannually with IABP (60%). The most common method ofwithdrawing IABP support was ratio reduction alone (61%).ICUs most likely to undertake ratio weaning were higherendusers of IABP (> 20 cases per annum) (P = 0.04). Otherweaning practices involved a combination of ratio followedby volume reduction (17%), volume then ratio (11%), andvolume only (4%). Approaching statistical significance, ratioreduction weaning less frequently required IABP reinsertionor inotropic increase after balloon removal (P = 0.07). ICUswith documented weaning policies were less likely torequire IABP reinsertion or inotropic increase after balloonremoval (P = 0.06). Criteria considered important beforeIABP weaning or removal were: blood pressure (92%); heartrate (76%); pulmonary artery wedge pressure (59%);noradrenaline dose (78%); adrenaline dose (57%); anddobutamine dose (57%). Ninety per cent of ICUs reportedincreasing inotropes after balloon removal only rarely (1:50patients) or occasionally (1:10 patients), while 87% of ICUsreported never needing to reinsert the balloon or only rarely.
Conclusion: The Australasian approach to IABP weaning iseclectic. While ratio reduction weaning appears the mostsuccessful manner of support withdrawal, it may be aconsequence of a volume-outcome relationship, with high-end users achieving better results through IABP familiarity.
Crit Care Resusc 2006; 8: 361-367
