Intraaortic Balloon Pump (IABP) - Stanford University
Intraaortic Balloon Pump (IABP)
-Two Main Goals: 1. support hemodynamics 2. improve coronary perfusion
-Duration of support should be short due to complications
Indications:
-*Cardiogenic Shock – initially post-surgical
-*Refractory unstable angina – chest pain refractory to optimum med mgt
-High risk PCI – LM disease, LV dysfunction, LM equivalent (40%), CHF
-Bridge to Transplant – Not practical for long period time; usually need VAD
-Mechanical complications of MI – acute MR, VSD (prior to surgery)
-Decompensated AS
-Refractory ventricular arrhythmias
Contraindications:
-AI
-Aortic dissection – catheter may extend dissection
-Abdominal or thoracic aneurysm – dislodge atheroemboli/Ao dissect/Ao rupture
-Severe PVD – given high degree of limb complications
Hemodynamics
-Decreased Afterload - negative pressure during systole, increase CO 20%,dec PCWP
-Augment Cor Perfusion – during diastole; no improvem of stenosed vess; dec wall stress
|[pic] |[pic] |
Normal Balloon Inflation
[pic]
Placement
-Done under fluoroscopy, large sheath used (9-11Fr)
-Tortuous iliofemoral vessels may preclude insertion
-helium gas used to inflate/deflate
-IV heparin/Ancef
-patient must lie supine
- Monitor with Daily CXR, pulses, platelet counts/HCT
Timing
-Ideal inflation just before dicrotic notch
-Deflation prior to onset of next systolic pressure waveform
-timing coordinated with EKG, but adjusted manually
|Early Inflation |Late Inflation |
|[pic] |[pic] |
| | |
|Early Deflation |Late Deflation |
|[pic] |[pic] |
Complications
-Vascular(5-20%) – ischemia – remove, bleeding (around site – pressure / hematoma – tx)
-Infection – rare
-Balloon Rupture – balloon augmentation ceases; helium embolus, clots – surgical remov
-Balloon entrapment – clot prevents removal – fluoroscopy
-Hemolysis/thrombocytopenia – shear forces (PLT rarely < 50)
-renal failure/mesenteric ischemia/CVA
Weaning
- 1:2 -> 1:4 -> 1:8 then back to 1:1 | -Heparin off for 4 hrs and pull once PTT at goal
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