IABP is thought to be the savior when PCI is done in severely compromised left ventricle and in other high risk angioplasties. Without verifying the facts, routine use of this device became rampant in cath labs around the world in the last decade .
Everyone strongly believed , IABP plays a major role in sustaining coronary perfusion during complex PCIs. Then the favorable experience started pouring in, from many cath labs without IABP support . Common sense struck us , and some one asked this question .
Should we routinely insert IABP in all cases of high risk PCI. ?
The study , published in JAMA 2010 convincingly answers this question
Can you do a high risk PCI without IABP back up facility ?
In academic sense “No” .
IABP service is not available in many cath labs in India for various reasons .But it does not become a contraindication to attempt PCI on them .At least , we should have facility to shift the patient to a nearby advanced cardiac care centre in case the need arises.
In plain language (Politeness removed !) routine prophylactic IABP is not only useless , it could also carry a danger of access site , procedure , expertise (Lack of it ! ) related hazards. Remember the Swan Ganz story !