Background
There is increasing evidence that certain cardiac surgery patients benefit from a period of preoperative augmentation with the intra aortic balloon pump. The aim for this update metanalysis is to look for new RCTs since 2010 and update the decision making process when using IABP during CABG for high risk cases.

Material and Methods
Randomised controlled trials (RCTs) of any size or length were included. Data collection and analysis papers were assessed for inclusion by two authors independently and differences were settled by consensus with a third author. Date are presented in the form of odds ratios (OR) and 95% confidence intervals (CI).

Results
In the last metanalysis six trials were included. This update adds the results of four further trials. Data from a total of 556 patients were included in the meta-analysis of mortality outcomes; 7 studies on-pump and 3 studies off pump. Generally, the patients were considered as “high risk” and 286 were treated preoperatively with IABP and 240 served as controls. There were fourteen hospital deaths in the intervention arm and 32 in the non-intervention arm (OR 0.18, 95% CI 0.08 to 0.41; P<0.0001).Clear Benefit has been recorded of the use of the IABP in female population.

Conclusion
Evidence suggests that preoperative IABP may have a beneficial effect on mortality and morbidity in specific high risk patient groups undergoing on or off pump coronary artery bypass grafting. The use of the IABP on the female high risk cases looks to be beneficial.