Comparison of Heart Failure Cardiogenic Shock Patients with Axillary and Femoral Intra-aortic Balloon Pump: Cardiogenic Shock Working Group report

Background: IABPs traditionally are placed via the femoral artery. Single-center studies have shown the utility of axillary placement to promote ambulation. The utility of Ax IABP in CS has not been established. Therefore, we sought to describe the outcomes of patients receiving axillary (Ax) intra-aortic balloon pump (IABP) and compare them with those receiving femoral (Fem) IABP for heart failure-related cardiogenic shock (HF-CS). Methods: Data from 2020 to 2023 from the Cardiogenic Shock Working Group, a multicenter academic consortium, were analyzed. We examined the demographic, metabolic, hemodynamic characteristics, and outcomes of patients with HF-CS treated with Ax-IABP and compared them with those who primarily received a Fem-IABP. Results: Of 6201 CS patients in the registry, 557 (8.9%) patients received an IABP for HF-CS, of whom 244 (43.8%) and 313 (56.2%) received Ax-IABP and Fem-IABP, respectively. Compared with Fem-IABP, patients who received Ax-IABP were more likely to have previous intracardiac defibrillators (42.5% vs 68.9%, P < .001). Time to IABP implant from admission (7.9 ± 10.6 vs 1.8 ± 6.1, P < .01) and duration of support (9.6 ± 14.6 vs 4.0 ± 4.5, P < .01) were longer among Ax-IABP, relative to Fem-IABP. Patients who received Ax-IABP were more likely to undergo heart-replacement therapy (65% vs 21%, P < .001) compared with the Fem-IABP cohort. The rate of reported complications was similar between the 2 groups. Conclusion: Axillary IABP is being used beyond single-center reports to support HF-CS mostly as a bridge to heart-replacement therapies. Its use might provide advantages over fem-IABP.