Objectives: The intra-aortic balloon pump (IABP) was first introduced in 1968 to augment cardiac output in the haemodynamically unstable patient and serve as a bridge to treatment options such as coronary artery bypass grafting and cardiac transplantation. Transfer of IABP-dependent patients for upgrade of clinical care is increasingly common and safe. In Australia, percutaneous coronary intervention centres can be located outside cardiothoracic surgical centres. This study reviews IABP medical retrieval by a doctor/paramedic team after implementation of a standardized protocol.
Methods: This was a retrospective case series review, using descriptive statistics.
Results: Greater Sydney Area Helicopter Emergency Service carried out 22 cases from 1 May 2007 to 31 December 2009. Median age was 62 years [interquartile range (IQR) 51-83], 67% were male. In all, 63% of patients were retrieved on inotropic support, 29% overall received invasive ventilation. Highest frequency indications were myocardial infarction, cardiogenic shock and bridge to coronary artery bypass grafts. There were complications during 18% of all retrievals and no adverse outcomes. Of the patients, 67% (14/21) were retrieved by road and 33% (7/21) by helicopter (longest distance 500 km). Median stabilization time by a retrieval team was 1 h 15 min (IQR 50 min to 3 h 30 min). Median mission time was 4 h 55 min (IQR 3 h 50 min to 8 h 54 min).
Conclusion: Our system offers a safe method of IABP medical retrieval. The doctor and paramedic combination complements strengths in logistics and critical care. This serves as a guide to other systems looking to put in place a similar model of care.