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December 1968

Counterpulsation and Intraaortic Balloon Pumping in Cardiogenic Shock: Circulatory Dynamics

Author Affiliations

Bronx, NY
From the Department of Surgery, Albert Einstein College of Medicine, Bronx, NY.

Arch Surg. 1968;97(6):991-999. doi:10.1001/archsurg.1968.01340060169020

THE MORTALITY of shock associated with myocardial infarction has been reported as between 24% and 93%1 with averages in the range of 70% to 80%, depending upon criteria of diagnosis. Because of the failure of medicinal therapy including vasopressors to salvage the majority of such patients, recent emphasis has been placed on mechanical means for assisting the acutely failing heart. Of the available methods, cardiopulmonary bypass2 invokes the need for major surgery and causes significant injury to the cellular components of blood. Venoarterial pumping does not increase central aortic pressure and coronary perfusion,3 nor does it reduce left ventricular work and may, in fact, increase it; its primary application is in right heart failure. Bypass of the left side of the heart without thoracotomy4 does reduce left atrial pressure and ventricular work, but significant injury to large vessels and cardiac chambers may result from the rigid