Intra-Aortic Balloon Pump Counterpulsation Iskander Al-Githmi, MD, FRCSC Assistant Professor of Surgery King Abdulaziz University
Dec 27, 2015
Intra-Aortic Balloon Pump Counterpulsation
Iskander Al-Githmi, MD, FRCSC
Assistant Professor of Surgery
King Abdulaziz University
Historical Perspective
• 1958- Harken: Described the diastolic augmentation and counterpulsation to treat LV failure
• 1962-Moulopoulus: From Cleveland clinic, developed an experimental (IAB) whose inflation and deflation were timed to cardiac cycle
• 1968-Kantrowitz: Introduce the (IAB) to the clinical practice in patient with post-infarction cardiogenic shock
Intra-Aortic Pump Catherter
Physiologic effect of IABP
• Reduction of left ventricular afterload
• Increase aortic root pressure and coronary perfusion
• Decrease myocardial oxygen demand
Coronary Artery Flow Autoregulation
• Flow=Pressure/ resistnce
Indications:
• Cardiogenic shock or pump failure
• Unstable angina
• Failure to wean patient off CPB Prophylaxis:
• High grade left main coronary stenosis
• Post infarction acute mitral regurgitation and septal defect
Contraindications:
• Severe aortic regurgitation
• Aortic dissection
• Severe peripheral vascular disease
• Non-salvageable patient- Irreversible brain injury
Arterial Waveform
IABP Arterial Waveform
IAB catheter insertion technique
• Seldinger technique
• Cut-down
Timing
Balloon pressure waveform
1.zero baseline2.Fill pressure baseline3.IAB inflation4.Pressure artifact/positive overshoot5.Plateau pressure (IAB inflated)6.IAB deflation7.Vaccum artifact/negative overshoot8.Return to baseline (IAB deflated)
Timing Basics
• To patient arterial waveform (always)
• To patient EKG signal
Timing problems
• Early inflation
Timing Problems
• Early deflation
Timing Problem
• Late deflation
Triggering
• Trigger on the R wave- preferred method
• Good quality EKG signal and lead i.e unidirectional QRS complex, R wave is taller than P and T waves also it has adequate amplitude
Triggering
Good Lead
Triggering
• QRS complex cause wandering timing
Complications
• Limb ischemia (10-25%)• Balloon rupture• Thrombosis within the balloon • Infection • Bleeding• False aneurysm • Femoral neuropathy• Lymphocele
Questions
Question1
Asses the timing in the following strip
a. Correct Timingb. Early inflation and late deflationc. Early inflation and early deflationd. Correct inflation and early deflatione. Late inflation and early deflation
Question 2
What is wrong with the arterial pressure line
a. AP line is dampenedb. Transducer need to zerodc. The IBP is too high and the tip of art.line is being occluded as it hit the archd. Nothing e. There is air in the pressure tubing
Question 3
Asses the timing in the following strip
a. Early inflation and early deflationb. Late inflation and late deflationc. Correct inflation and late deflationd. Late inflation and early deflatione. Correct timing
The pump is the peak trigger mode ,what part of the EKG complex is being recognized as the trigger event?
a. The R wave
b. The pacer spike
c. The arterial pressure waveform
d. The T wave
e. No trigger is seen
Question 5
The indications for IABP therapy include:a. Cardiogenic shock following acute myocarditis
b. Acute mitral regurgitation with pulmonary edema from papillary muscle rupture
c. Acute VSD following myocardial infarction
d. Acute aortic regurgitation from edocarditis