Intraaortic Balloon Pump (IABP)



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] |

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|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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