The intelligence of Dr. Adrian Kantrowitz has introduced to medical science a significant contribution in cardio management for patients with heart condition. By creating the intra-aortic balloon pump, the device becomes a widely used tool for circulatory support in the medical field. The intra-aortic balloon pump (IABP) is a mechanical device used to help the heart pump efficiently throughout the body. It works by reducing the workload of the heart, allowing it to pump more blood.
The IABP is a very useful tool and is widely used to assist the patient in coping with circulatory failure and cardiogenic shock. Cardiogenic shock is the end-organ tissue hypoperfusion giving rise to a number of compensatory mechanisms such as peripheral vasoconstriction, tachycardia and neurohormonal regulatory activation worsening the left ventricular dysfunction. The primary goal of intra-aortic balloon pump is to improve the ventricular performance of an injured heart by increasing myocardial oxygen supply and decreasing myocardial oxygen demand. The IABP device is composed of the pump and the console.
The intra-aortic balloon pump
The balloon is a dual lumen catheter made up of polyethylene and is inflated with gas (mostly helium as it is easily absorbed in the blood stream in case of rupture of the balloon). Before the insertion, the appropriate balloon size is determined which is based on the patient’s height. The balloon is ascended into the aorta through the femoral artery in the leg. It is placed in the descending aorta which is approximately 2cm from the left subclavian artery and the procedure is guided by fluoroscopy.
The intra-aortic balloon console
The pump console is the external machine where the balloon catheter is attached. This has control pads that drive the balloon depending on the prescribed timing or ratio for the patient. The console is programmed to identify a trigger for the balloon to inflate or deflate. The usual triggers that are used include ECG waveform and the systematic arterial waveform. Based on the patient’s Hemodynamic status, the timing of the device is set to assist every beat.
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How does IABP works?
Counter-pulsation is the term used to describe the balloon inflation and deflation. During diastole, the balloon inflates which increases the pressure in the aorta than the pressure of the left ventricle thereby causing increased coronary blood flow and myocardial oxygen supply. During systole, the balloon deflates causing a decrease in after load and allowing the heart to pump more blood going to the systemic circulation. This also causes decreased myocardial oxygen consumption and decreased cardiac work.
What are the indications of IABP?
- Unstable angina and acute myocardial infarction by increasing the myocardial oxygen supply versus the demand
- Ventricular arrhythmia by increasing coronary perfusion
- Cardiogenic shock that has not been reversed by pharmacological therapy
- Support during cardiac surgeries especially when the patient does not tolerate weaning from cardiopulmonary bypass
Hemodynamic instability would likely result from suboptimal timing of inflation and deflation of the IABP. Weaning from IABP should be monitored and assessed well by the Healthcare team. It should also be considered that the patient’s inotropic requirements are minimal but not totally absent so that there is still some leeway if in case the patient will not be able to tolerate weaning. Weaning is also gradually by reducing the ratio of augmented to non-augmented beats (1:2 to 1:14) and/or decreasing the balloon volume. Constant evaluation of Hemodynamic status, systemic and peripheral perfusion and relief of cardiac symptom is imperative. The healthcare team should also monitor for early signs of complications such as ischemia, balloon malfunctioning, thrombus formation, bleeding and infection. Ensuring the proper functioning of the IABP, including correct timing, consistent triggering and troubleshooting of the alarms is the responsibility of the healthcare team.
If you are suffering from a circulatory disease, make sure to make a doctor appointment immediately to obtain proper medical help. Modern technology such as the intra-aortic balloon pump can help improve your health.