Intra-aortic balloon counterpulsation in acute myocardial infarction: too few or too many?

The concept of counterpulsation was introduced over four decades ago by Clauss et al. (1) and adapted to intra-aortic balloon pumping (IABP) by Moulopaulus et al. (2) in 1962, and it remains the most common mode of cardiac assist. Intra-aortic balloon counterpulsation (IABCP) was first introduced into clinical practice by Kantrowitz et al. (3) in 1968 for the treatment of cardiogenic shock. Initially, the 12F to 14F intra-aortic balloon (IAB) catheter required surgical insertion via a dacron graft sutured to the femoral artery. In 1979, the IAB was adapted for percutaneous insertion by Bregman and Casarella (4), and this was followed in the early 1980s by a dual-lumen, wire-guided, smaller catheter device which could be placed in 5 min with significantly improved insertion success and reduced vascular complications (5–8). Refinements have reduced the catheter size to 8F and 9F for 30to 50-cc balloons, and technically advanced consoles can rapidly shuttle the helium gas with automatic timing.