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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
slide25
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

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