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Using EuroSCORE to select patients for prophylactic IABP

Mater Misericordiae University Hospital, National Centre for Cardiothoracic Surg, Dublin 7, Ireland

EuroSCORE directed intraaortic balloon pump placement in high-risk patients undergoing cardiac surgery – retrospective analysis of 267 patients

We congratulate this group for attempting to address what we regard as a very interesting and practical point [1].

There is some evidence that preoperative elective placement of an IABP in high risk patients prior to cardiac surgery may improve their outcomes. However, the complications of IABP placement are significant. Therefore the question of interest is how to define a high risk patient so that the risk to benefit ratio is favourable. The use of a preoperative risk calculator would be ideal as it would be easily reproducible in any cardiac surgery centre and therefore the results of any trials or observational studies could easily be reproduced.

The authors of this study imply in the title of their study that they have used the EuroSCORE to select suitable patients for preoperative IABP placement. However, this is a retrospective review and they have made no attempt to analyse the population who received an IABP preoperatively based on their EuroSCORE. The preoperative placement population should be divided into low, intermediate and high risk groups using the EuroSCORE and the survival of these groups assessed and compared to similar EuroSCORE patients who did not receive a preoperative IABP. Our previously published work cited by the authors does this and we found that patients with a preoperative additive EuroSCORE of >5 were the patients who benefited most from preoperative IABP placement [2]. We agree with the practise of this study however in not including the preoperative IABP in the EuroSCORE calculation for this group. The utility of the score is in the decision making regarding the placement of an IABP in an otherwise stable patient. It is the score of the patient before the IABP is placed that will influence the decision to place it.

This study used 175 IABPs in a population of 267 (65%) and used 85 IABPs to wean patients from cardiopulmonary bypass support. This is a very significant IABP usage and must be significantly higher than the majority of centres. The analysis of intra and postoperative IABP placement we feel is a distraction from the main question. These patients are having IABP placed in result to contemporaneous clinical need. Whereas the most interesting group is the patients who have IABP placed in anticipation of future benefit where no immediate need is perceived.

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1. Diez C, Silber RE, Wachner M, Stiller M, Hofmann HS. EuroSCORE directed intraaortic balloon pump placement in high-risk patients undergoing cardiac surgery – retrospective analysis of 267 patients. Interact CardioVasc Thorac Surg 2008;7:389–397.[Abstract/Free Full Text]
2. EuroSCORE: Useful in directing pre-operative intra-aortic balloon pump placement in cardiac surgery? Healy DG, Veerasingam D, Wood AE. Heart Surg Forum 2006;9:E893.[CrossRef][Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): David Healy Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Healy, D. Articles by Wood, A.E. Search for Related Content PubMed Articles by Healy, D. Articles by Wood, A.E. Related Collections Related Article