Hospital level variation in the use of intensive care. It consists of a cylindrical polyurethane balloon that sits in the aorta, approximately 2 centimeters (0.79 in) from the left subclavian artery. They concluded that the outcomes for deceased donor kidney transplantation in the US were not affected by the day of surgery [16]. Patients covered under Medicare made up a greater percentage of the total patient populations on the weekends relative to the weekdays (49.56% vs. 32.59%, p < 0.001). "The impact of anticoagulation during intra-aortic balloon counterpulsation pump placement on in-hospital outcomes in 18,875 patients undergoing cardiac revascularization." Placement of IABPs are associated with many risks, such as major limb ischemia and mortality [17]. statement and Historically, IABPs are inserted through the femoral artery and patients are placed on bed rest. The study was approved by the Institutional Review Board at the Massachusetts General Hospital (16-05-2558). Influence of insurance status on hospital length of stay and discharge location in burn patients. "The role of heparin anticoagulation during intra-aortic balloon counterpulsation in the coronary care unit." Parissis H, Graham V, Lampridis S, Lau M, Hooks G, Mhandu PC. "The impact of anticoagulation during intra-aortic balloon counterpulsation pump placement on in-hospital outcomes in 18,875 patients undergoing cardiac revascularization." The discovery of this trend indicates the need for further investigations into the clinical reasons given for placement of IABP and may reflect an underlying disagreement with current practice guidelines. Aorto‐iliac stenoses can be managed with angioplasty or stent placement; however, there are limited data about this strategy to facilitate IABP placement. However, the literature is mixed regarding surgical outcomes when comparing weekend to weekday admission. Given the wide variability with respect to the timing and indication of IABP placement, specifically in the pre-operative patient with coronary artery disease (CAD) we believe the placement of IABPs in this patient population serves as an effective case study in the evaluation of a non-clinical factor that may influence clinical decision making. NLM Therefore, further qualitative research should investigate the role of patient behaviors on this weekend effect to determine the best way to standardize the procedure. Introduction: Intra-Aortic Balloon Pumps (IABPs) can be utilized to provide hemodynamic support in high risk patients awaiting coronary artery bypass grafting (CABG). Similarly, because OSHPD does not provide the data necessary to distinguish between emergent, elective, and urgent patient cases, this study was unable to stratify on the basis of severity and urgency of cases.  |  The findings of the Dartmouth atlas project: a challenge to clinical and ethical excellence in end-of-life care. Unnecessary surgery. Aortic dissection and arterial perforation may occur infrequently Intra-aortic Balloon Pump. Google Scholar. 2013;28(Suppl 3):646–53. Inasmuch, the care of patients who present with cardiac conditions has increasingly become more team based and multidisciplinary. The IABP is not coded as a device within ICD-10-PCS and is coded with the root operation of “Assistance.” The ICD-10-PCS code for insertion of an IABP for continuous pumping would be 5A02210, Extracorporeal or Systemic Assistance, Physiologic Systems, Assistance, Cardiac, Continuous, Output, Balloon Pump. Chin, Chee Tang, et al. Thirty‐seven IABPs were placed in 35 patients. Introduction. MediCal and Medicare patients were also more likely to have an in-hospital mortality compared to those with private insurance (OR: 1.66, CI: 1.29–2.14, p < 0.001 and OR: 1.50, CI: 1.24–1.82, p < 0.001 respectively). Intraaortic balloon pump, commonly called IABP, is a catheter-based procedure reserved for patients with severe heart disease (e.g. Coronary artery bypass grafting; Coronary artery disease; Intra-aortic balloon pump. Intra-aortic balloon pump (IABP) is the most frequently used mechanical assist device in high risk cardiac surgery patients. PubMed  Google Scholar. PubMed Central  2016;6:4. Google Scholar. 2012;12:87. Interestingly, we found that the likelihood of preoperative IABP placement was significantly less likely in non-teaching hospitals than teaching hospitals (OR: 0.67, CI: 0.48–0.93, p 0.018). Furthermore, the age of the data (2006–2010) available from the database limits the scope of our findings and warrants further investigations to determine if this trend has held. The odds of preoperative IABP placement prior to CABG is significantly increased on weekends compared to weekdays, even when controlling for clinical factors. Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality-A meta-analysis of 9,212 patients. Please enable it to take advantage of the complete set of features! Leape LL. volume 15, Article number: 219 (2020) Intra-aortic balloon pump (IABP) is a commonly used modality for mechanical circulatory support (MCS) in patients with cardiogenic shock. These patients will then remain in the intensive care unit with IABP hemodynamic augmentation until they undergo surgical revascularization. An intra-aortic balloon pump (IABP) is a type of therapeutic device. Lancet. Springer Nature. The need to minimize non-clinical factors is highlighted by several interesting ancillary findings found in this study. Intraaortic Balloon Pump Placement (IABP) IABP or intraaortic balloon pump placement is a procedure where a small balloon is passed into the aorta to assist with pumping the blood throughout the body as well as relaxing. An intra-aortic balloon pump (IABP) is a short-term catheter solution to help the heart pump blood. This website was created to help train anyone involved in caring for Cardiac and Thoracic Surgical patients. The modern intra … Patients treated at non-teaching hospitals had an increased odds of in-hospital mortality compared to those treated at teaching hospitals (OR: 1.33, CI: 1.13–1.56, p = 0.001). For example, Baid-Agrawal and colleagues examined the outcomes of renal transplantation when performed on a weekend versus a weekday using the UNOS database. Am Surg. We included all patients who underwent CABG in our analysis. CAS  There are many indications for IABP and institutional practice patterns regarding the placement of IABPs is variable. Thoralf M. Sundt: Concept of idea, study design, manuscript editing and revisions. Google Scholar. Intra-aortic balloon pump (IABP) counterpulsation is a useful circulatory support adjunct in the setting of refractory cardiogenic shock in critically ill patients. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. Aorto‐iliac stenoses can be managed with angioplasty or stent placement; however, there are limited data about this strategy to facilitate IABP placement. ↵ † Pneumothorax as direct consequence of IABP implantation, assessed by chest radiography. The IABP inflates in diastole, increasing blood flow to the coronary arteries. Sabra MJ, Andrews WG, Crandall ML, Pirris JP. It has been shown that the process by which consensuses are developed may influence the results and acceptability of the results. BMC Health Serv Res. Intraaortic balloon pump replacement (IABP) is the most widely used circulatory assist device today and is utilized in a wide range of serious cardiovascular conditions. Notably, one indication for placement of an IABP is for prophylaxis in patients deemed high risk prior to undergoing surgical revascularization with coronary artery bypass grafting (CABG) [10]. As a result, the preoperative placement of an IABP in a patient awaiting CABG is not standardized and may vary according to non-clinical factors. A total of 46,347 patients underwent CABG, of which 8148 (18%) were admitted on the weekend (Saturday/Sunday) and 38,199 (82%) on a weekday (Monday-Friday). Keywords: The World Health Report 2000. 2001;72(1):54–7. Intra-aortic balloon pump (IABP) is a cylindrical polyethylene device inserted into the descending thoracic aorta, which increases myocardial oxygen delivery and cardiac output [1]. This may be related to the variety of clinical indications for which an IABP is placed, as well as physician judgment which cannot be controlled for in a retrospective study. The OSHPD database is powerful and allowed us to evaluate a wide range of both clinical and non-clinical data over a five-year period. CAS  Am Surg. The aim of our study was to evaluate intra-aortic balloon pump (IABP) placement technique related morbidity in cardiac surgical patient population. Study on Early Intra-aortic Balloon Pump Placement in Acute Decompensated Heart Failure Complicated by Cardiogenic Shock (Altshock-2) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. A multivariable logistic regression analysis to identify predictors of IABP placement was performed, adjusting for patient demographics, clinical factors, and system variables. It is estimated that 10–20% of all medical procedures performed may be medically unnecessary, subjecting patients to avoidable risks without any clinical benefit [1,2,3]. In this study we assessed whether the aortic knob is a reliable landmark for positioning the IABP and compared it with another potential landmark, the carina. Keywords: intra aortic balloon pump, IABP, complications by the use of intra aortic balloon pump Introduction The complication rates when using an intra aortic bal-loon pump are high and may account for up to 50% according to Harvey et al [1], with an average 20-30% [2,3]. It is a long, thin tube called a catheter with a balloon on the end of it. Kantrowitz1 described augmentation of coronary blood flow by retardation of the arterial pressure pulse in animal models in 1952. From a coding perspective, the IABP is not classified as a device such as the VAD’s. All patients admitted for CABG were included. ), and/or while waiting for a heart transplant. A p-value of less than 0.05 was considered statistically significant. Amy Fiedler: Concept of idea, creation of study design, significant contribution to manuscript preparation, editing, revisions. 2011;22(3):267–76. Patients who died within 24 h of admission and those who had absolute contraindications to IABP placement were excluded. Odds ratios (OR) are presented with 95% confidence intervals (CI). Creating and adhering to specific clinical guidelines regarding IABP placement may also reduce this unwanted variation. Arterial pressure tracing from a patient with an intra-aortic balloon pump. The global role of health care delivery science: learning from variation to build health systems that avoid waste and harm. California Privacy Statement, 2020 Jan;35(1):113-117. doi: 10.1111/jocs.14367. A retrospective cohort analysis of the Office of Statewide Health Planning and Development database from 2006 to 2010 was performed. heart attack, congestive heart failure, etc. In 196… Arroyo NS, White RS, Gaber-Baylis LK, La M, Fisher AD, Samaru M. Racial/Ethnic and Socioeconomic Disparities in Total Knee Arthroplasty 30- and 90-Day Readmissions: A Multi-Payer and Multistate Analysis, 2007-2014. Intra-aortic balloon pump placement in coronary artery bypass grafting patients by day of admission. An intra-aortic balloon pump, or IABP, is a long, skinny balloon that controls the flow of blood through your largest blood vessel, the aorta. This site needs JavaScript to work properly. A retrospective cohort analysis of the Office of Statewide Health Planning and Development database from 2006 to 2010 was performed. PubMed  We hypothesize that the rate of IABP placement varies by day of the week. Patients with prophylactic IABP placement before OPCAB presenting between January 1, 2010 and December 31, … PubMed  Listing a study does not mean it has been evaluated by the U.S. Federal Government. Intra-Aortic Balloon Pumps (IABPs) can be utilized to provide hemodynamic support in high risk patients awaiting coronary artery bypass grafting (CABG). Study on Early Intra-aortic Balloon Pump Placement in Acute Decompensated Heart Failure Complicated by Cardiogenic Shock (Altshock-2) The safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Because of the known clinical risks associated with the placement of IABPs, it is prudent to reduce medically unnecessary IABPs in order to minimize complications associated with the device, and shorten hospital length of stay. Therefore, we hypothesize that there will be an increased rate of preoperative IABP placement prior to CABG on Saturdays and Sundays when operating rooms have reduced capacity to perform non-scheduled cases. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Article  The balloon pump was placed on one-to-one augmentation. 2011;6(1):147. Unnecessary surgery. Intra-Aortic Balloon Pumps (IABPs) can be utilized to provide hemodynamic support in high risk patients awaiting coronary artery bypass grafting (CABG). https://doi.org/10.1186/s13019-020-01259-z, DOI: https://doi.org/10.1186/s13019-020-01259-z. There have been few examples looking at variations in practice patterns by non-clinical factors. Deppe AC, Weber C, Liakopoulos OJ, Zeriouh M, Slottosch I, Scherner M, Kuhn EW, Choi YH, Wahlers T. J Card Surg. 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