Balloon pumps and AMI
FORMATION ANGLAIS
Patients who experience cardiogenic shock after acute myocardial infarction (AMI) have alarmingly high mortality rates, and judging from a new German study
An IABP is a counterpulsation device that provides temporary cardiac assist in the management of refractory left ventricular failure.
It has been credited with enhanced coronary blood flow, increased perfusion of vital organs, maintenance of infarct artery patency, and decreased systemic inflammation. The study set out to compare the efficacy of IABP counterpulsation with that of standard therapy.
600 patients were randomly assigned to either an IABP treatment group or a non-IABP control group. At 30 days, all-cause mortality was similar among patients in the two groups – 39.7 % and 41.3 % respectively. In conclusion, there were no significant differences between the groups in rates of stroke, bleeding, sepsis, or peripheral ischemic complications. « The data don’t support the routine use of an IABP in AMI patients with cardiogenic shock. »
Outcomes of the study include the need to revascularize the patient as soon as possible ; the need for nurses to share when they have seen patients improve hemodynamically with the use of IABPs to improve evidence-based data collection. Further studies may question whether IABPs lower mortality rates from 6 months or if they help specific populations.
D’après l’American Journal of Nursing : November 2012 – Volume 112 – Issue 11 – p 13
1– Étude : Thiele H, et al. N Engl J Med. 2012;367(14):1287–96
2– Editorial : O’Connor CM, Rogers JG N Engl J Med. 2012;367(14):1349–50
MOTS ET EXPRESSIONS
Survival (n)
Survie
Vital organs (adj + n)
Organes vitaux
Patency (n)
Ouverture ; ici, perméabilité
To set out to (do something) (v)
S’apprêter à faire quelque chose ; avoir l’intention de, viser à
Stroke (n)
Accident vasculaire cérébral
Sepsis = bacteremia (n)
Bactériémie ; infection bactériologique du sang
QUESTIONS
1. Do the authors suggest that IABP use in case of cardigenic shock after AMI is unnecessary ?
No, they conclude the data show no benefit after 30 days. Further research is required.
2. What nursing roles are encouraged by the study ?
a) Revascularizing patients as soon as possible ;
b) Contributing to data collection by giving feedback on patients who improve hemodynamically.
3. Name two avenues for future research.
a) Mortality rate from 6 months on ?;
b) population-specific benefits.