Intra aortic balloon pump counterpulsation
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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

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Intra aortic balloon pump counterpulsation

Intra-Aortic Balloon Pump Counterpulsation

Iskander Al-Githmi, MD, FRCSC

Assistant Professor of Surgery

King Abdulaziz University


Historical perspective
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



Physiologic effect of iabp
Physiologic effect of IABP

  • Reduction of left ventricular afterload

  • Increase aortic root pressure and coronary perfusion

  • Decrease myocardial oxygen demand


Coronary artery flow autoregulation
Coronary Artery Flow Autoregulation

  • Flow=Pressure/ resistnce


Indications
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
Contraindications:

  • Severe aortic regurgitation

  • Aortic dissection

  • Severe peripheral vascular disease

  • Non-salvageable patient- Irreversible brain injury




Iab catheter insertion technique
IAB catheter insertion technique

  • Seldinger technique

  • Cut-down



Balloon pressure waveform
Balloon pressure waveform

1.zero baseline

2.Fill pressure baseline

3.IAB inflation

4.Pressure artifact/positive overshoot

5.Plateau pressure (IAB inflated)

6.IAB deflation

7.Vaccum artifact/negative overshoot

8.Return to baseline (IAB deflated)


Timing basics
Timing Basics

  • To patient arterial waveform (always)

  • To patient EKG signal


Timing problems
Timing problems

  • Early inflation


Timing problems1
Timing Problems

  • Early deflation


Timing problem
Timing Problem

  • Late deflation


Triggering
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


Triggering1
Triggering

Good Lead


Triggering2
Triggering

  • QRS complex cause wandering timing


Complications
Complications

  • Limb ischemia (10-25%)

  • Balloon rupture

  • Thrombosis within the balloon

  • Infection

  • Bleeding

  • False aneurysm

  • Femoral neuropathy

  • Lymphocele



Question1
Question1

Asses the timing in the following strip

  • Correct Timing

  • Early inflation and late deflation

  • Early inflation and early deflation

  • Correct inflation and early deflation

  • Late inflation and early deflation


Question 2
Question 2

What is wrong with the arterial pressure line

  • AP line is dampened

  • Transducer need to zerod

  • The IBP is too high and the tip of art.line is being occluded as it hit the arch

  • Nothing

  • There is air in the pressure tubing


Question 3
Question 3

Asses the timing in the following strip

  • Early inflation and early deflation

  • Late inflation and late deflation

  • Correct inflation and late deflation

  • Late inflation and early deflation

  • Correct timing


The pump is the peak trigger mode ,what part of the EKG complex is being recognized as the trigger event?

  • The R wave

  • The pacer spike

  • The arterial pressure waveform

  • The T wave

  • No trigger is seen


Question 5
Question 5 complex is being recognized as the trigger event?

The indications for IABP therapy include:

  • Cardiogenic shock following acute myocarditis

  • Acute mitral regurgitation with pulmonary edema from papillary muscle rupture

  • Acute VSD following myocardial infarction

  • Acute aortic regurgitation from edocarditis


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