Transcript Document
Intra Aortic Balloon Pump James Hayward October 2014 General principle • The placement of an inflatable balloon into the descending aorta which willd rapidly during diastole and deflates during systole: • Reduce systolic pressure and therefore afterload • Increase diastolic pressure and therefore coronary perfusion • Improved coronary perfusion results in improved ejection, reduced enddiastolic pressure and reduced wall tension, thereby reducing cardiac work • Intended as a bridging device to reach definitive care or following definitive care to allow for physiological improvement Indications for IABP • Refractory ventricular failure • Cardiogenic shock • Unstable refractory angina • Impending infarction • Mechanical complications due to acute myocardial infarction • Ischemia related intractable ventricular arrhythmias • Cardiac support for high-risk general surgical and coronary angiography/ angioplasty patients • Weaning from cardiopulmonary bypass • Support for failed angioplasty and valvuloplasty Contra-indications to IABP Absolute Relative Aortic regurgitation Uncontrolled sepsis Aortic dissection Abdominal aortic aneurysm Chronic end-stage heart disease with no anticipation Tachyarrhythmias of recovery Aortic stents Severe peripheral vascular disease Major arterial reconstruction surgery Insertion and placement • It consists of a catheter and a pump/drive console. • The catheter has a long balloon mounted on the end. • It should be positioned so that the tip is approximately 1 to 2 cm below the origin of the left subclavian artery and above the renal arteries. • On chest x-ray the tip should be visible in the 2nd or 3rd intercostal space Operation • The balloon is made of polyethylene and is inflated with helium driven by the pump. • The balloon should be inflated at the start of diastole, just prior to the dicrotic notch. • The balloon rapidly deflates just before ventricular systole to reduce left ventricular work • Deflation creates a "potential space" in the aorta, reducing aortic volume and pressure • In most cases it is preferable to use the R wave of the ECG as the trigger signal • If the pump loses ECG signal or cannot detect R wave the pump will stop counter pulsating and will alarm • The arterial pressure waveform can be used as an alternative trigger • Pump HR should match other monitoring Possible challenges 1. Patient haemodynamics 1. Heart Rate 2. Stroke Volume 3. Mean Arterial Pressure 4. Systemic Vascular Resistance 2. Intra-aortic Balloon Catheter 1. IAB in sheath 2. IAB not unfolded 3. IAB position 4. Kink in IAB catheter 5. IAB leak 6. Low Helium concentration Weaning from IABP • If the patient’s cardiac performance improves, weaning from the IABP may begin by gradually decreasing the balloon augmentation ratio (from 1:1 to 1:2 to 1:4 to 1:8) under control of hemodynamic stability. • After appropriate observation at 1:8 counterpulsation the balloon pump is removed. Complications of IABP Transient loss of peripheral pulse Limb ischaemia Thromboembolism Compartment syndrome Aortic dissection Local vascular injury—false aneurysm, haematoma, bleeding from the wound Infection Balloon rupture (can cause gas embolus) Balloon entrapment Haematological changes, for example thrombocytopenia, haemolysis Malpositioning causing cerebral or renal compromise Cardiac tamponade Thanks