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100mmagine IABP colori

Balloon inflated in diastole and deflated in systole, to facilitate the stroke flow and maintain diastolic pressure.

Use

Only Helium or CO2 gas is used for balloon inflation. Also, its used for Emergency situations such as...

  • Heart Attack
  • Congestive Heart Failure
  • During stabilization awaiting cardiac procedure
  • During waiting period for anticipated heart transplant
  • Patients in CICUs & critically ill

History

The IABP device was pioneered at the Grace-Sinai Hospital in Detroit during the early 1960s by Dr. Adrian Kantrowitz. The device was developed for use in heart surgery by Dr. David Bregman in 1976 at NewYork-Presbyterian Hospital in New York City.

Use of counterpulsation

Intraaortic balloon counterpulsation is used in situations when the heart's own cardiac output is insufficient to meet the oxygenation demands of the body. These situations could include cardiogenic shock, severe septic shock, post cardiac surgery and numerous other situations.

Indications

The following situations may benefit from this device.

  • Cardiogenic shock when used alone as treatment for myocardial infarction 9-22% survive the first year.
  • Reversible intracardial mechanical defects complicating infarction, i.e. acute mitral regurgitation and septal perforation.
  • Unstable angina pectoris benefits from counterpulsation.
  • Post cardiothoracic surgery most common and useful is the use of counterpulsation in weaning patients from cardiopulmonary bypass after continued perioperative injury to myocardial tissue.
  • Preoperative use has been suggested for high-risk patients such as those with unstable angina with stenosis greater than 70% of main coronary artery, in ventricaular dysfunction with an ejection fraction less than 35%.
  • Bridge to heart transplant for those patients with left ventricular failure.
  • Percutaneous coronary angioplasty

Contraindications

Absolute contraindication

The following conditions will always exclude patients for treatment:

  • Aortic valve insufficiency
  • Aortic dissection
  • Severe aortoiliac occlusive disease

Relative contraindication

The following conditions could, under very pressing circumstances, be allowed to be included for therapy:

  • Prosthetic vascular grafts in the aorta
  • Aortic aneurysm
  • Aortofemoral grafts

Complications

Since the device is placed in the femoral artery and aorta it could provoke ischemia, and compartment syndrome. At highest risk is the leg which is supplied by the femoral artery may become ischemic, but also placing the balloon too distal from the arcus aortae may induce occlusion of the renal artery and subsequent renal failure. Other possible complications are cerebral embolism during insertion, infection, dissection of the aorta or iliac artery, perforation of the artery and hemorrhage in the mediastinum. Mechanical failure of the balloon itself is also a risk which entails vascular surgery to remove under that circumstance. After balloon removal there is also a risk of 'embolic shower' from micro clots that have formed on the surface of the balloon, and can lead to peripheral thrombosis, myocardial ischemia, hemodynamic decompensation, and late pseudoaneurysm. Other complications includes causing the balloon to rupture or leak and allow blood into the catheter, setting off a “failure to inflate”or “low gas”alarm.

Video

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