IABP ( Intra Aortic Balloon Pump )

1. IABP (IntraAorticBalloonPump) Presenter: Ms. Neelavathi II nd year M.Sc., Nursing

2. Introduction • Dr. Adrian Kantrowitz introduced the intra-aortic balloon pump (IABP) in the late 1960s as a simple yet effective device to increase coronary perfusion. • Because it is easy to insert, the IABP is the most widely used form of mechanical circulatory support. At the Texas Heart Institute • Although the IABP was first used for surgical patients, the pump can now be used along with interventional cardiology procedures and medical therapy (medications).

3. Indications for its use include: • Failure to wean from cardiopulmonary bypass. • Cardiogenic shock. • Heart failure. • Acute heart attack. • Support during high-risk percutaneous transluminal coronary (balloon) angioplasty, rotoblator procedures, and coronary stent placement.

4. The Pump • The IABP is a polyethylene balloon mounted on a catheter, which is generally inserted into the  aorta through the femoral artery in the leg. • The pump is available in a wide range of sizes (2.5 cc to 50 cc) that will fit patients of any age and size. • The balloon is guided into the descending  aorta, approximately 2 cm from the left subclavian artery. At the start of diastole, the balloon inflates, augmenting coronary perfusion.

5. IABP Sizing Chart

6. IABP Catheter • At the beginning of systole, the balloon deflates; blood is ejected from the left ventricle, increasing the cardiac output by as much as 40 percent and decreasing the left ventricular stroke work and myocardial oxygen requirements. In this manner,  the balloon supports the heart indirectly.

8. The Console • The IABP is driven by the balloon pump console. • The operating controls are located on a touch pad below the display monitor and can be programmed to produce rates as high as 140 beats per minute. • The on-board battery provides power for up to 2 hours. • The new CS100 IntelliSync console, with one-button start up, automatically adapts to patients' changing conditions.

9. Balloon Operating Console

10. What is an Intra Aortic Balloon Pump?

11. An intra-aortic balloon pump (IABP) is a mechanical device that helps the heart pump blood. • This device is inserted into the aorta, the body's largest artery. It is a long, thin tube called a catheter with a balloon on the end of it. • If you are hospitalized, your doctor may insert an IABP. • Your doctor will numb an area of your leg and thread the IABP through the femoral artery in your leg into your aorta.

12. He or she then positions the IABP at the center of your aorta, below your heart. • The doctor will use an X-ray machine during this procedure to help accurately position the IABP.

13. What is intra-aortic balloon pump therapy?

14. An intra-aortic balloon pump (IABP) is a type of therapeutic device. It helps your heart pump more blood. You may need it if your heart is unable to pump enough blood for your body. • The IABP consists of a thin, flexible tube called a catheter. • Attached to the tip of the catheter is a long balloon. This is called an intra-aortic balloon, or IAB. The other end of the catheter attaches to a computer console.

15. This console has a mechanism for inflating and deflating the balloon at the proper time when your heart beats. • The balloon is inserted into your aorta. The aorta is the very large artery leaving your heart. • In many cases, this procedure is done through a small cut on the inside of your upper leg. • Your healthcare provider will insert the balloon pump catheter into an artery in your leg. He or she will then guide it to your aorta • .

17. From there, the IABP can start to do its work. The balloon is set to inflate when the heart relaxes. • It pushes blood flow back toward the coronary arteries. • They may not have been receiving enough blood without the pump. When the heart contracts, the balloon deflates. • That allows the heart to pump more blood out to the body while using less energy. The device continues to inflate and deflate until it is removed.

18. An IABP is a short-term treatment. • You may need it until your heart condition improves or until you can receive a more permanent treatment. • Its use is rapidly growing. But it’s not yet available at all medical centers.

19. Indications for the use of IABP Acute myocardial infarction • IABP is aimed at achieving haemodynamic stability until a definitive course of treatment or recovery occurs. By decreasing myocardial work and SVR, intracardiac shunting, mitral regurgitation, or both (if present) are reduced while coronary perfusion is enhanced. • Severe mitral regurgitation secondary to papillary muscle dysfunction or rupture after myocardial infarction can lead to significant haemodynamic instability. • This can initially be managed by IABP, pending definitive surgery.

20. Refractory ventricular failure • IABP has a role in managing patients with refractory ventricular failure outside the setting of acute myocardial infarction, such as those with cardiomyopathy or severe myocardial damage associated with viral myocarditis. • This can aid the progression to more definitive treatments such as ventricular assist device or cardiac transplantation.

21. Cardiac surgery • IABP is used for stabilization of patients with acute myocardial infarction referred for urgent cardiac surgery. IABP support is often initiated in the cardiac catheterization laboratory and continued through the perioperative period. • Elective placement is considered in high-risk patients such as those with significant left main stem disease, severe LV dysfunction (ejection fraction <30%), congestive heart failure, cardiomyopathy, chronic renal failure, or cerebrovascular disease.

22. Ventricular arrhythmias • IABP is also effective in stabilizing patients with refractory ventricular ectopy after myocardial infarction by increasing the coronary perfusion pressure, reducing ischaemia and trans-myocardial wall stress, and maintaining adequate systemic perfusion.

23. Unstable angina • Unstable angina refractory to drug treatment is an indication for IABP. • These patients are at increased risk of developing acute myocardial infarction and death. • By improving the haemodynamic condition of these patients, IABP can facilitate further percutaneous interventions or bridge the patient to surgery.

24. Cardiogenicshock • This is life-threatening complication of acute myocardial infarction, is characterized by low cardiac output, hypotension unresponsive to fluid administration, elevated filling pressures and tissue hypoperfusion leading to oliguria, hyperlactaemia, and altered mental status. • IABP therapy is considered to be a class I indication (ACC/AHA guidelines) for the management of cardiogenic shock not rapidly reversed by pharmacological therapy.

25. Refractory ventricular failure • IABP has a role in managing patients with refractory ventricular failure outside the setting of acute myocardial infarction, such as those with cardiomyopathy or severe myocardial damage associated with viral myocarditis. • This can aid the progression to more definitive treatments such as ventricular assist device or cardiac transplantation.

26. Weaning from cardiopulmonary bypass may be difficult in cases where aortic cross-clamping is prolonged, revascularization is only partially achieved, or pre-existing myocardial dysfunction is present. Separation from cardiopulmonary bypass may be marked by hypotension and a low cardiac index despite the administration of inotropic drugs. • The use of IABP in this setting decreases LV resistance, increases cardiac output, and increases coronary and systemic perfusion, facilitating the patient’s weaning from cardiopulmonary bypass.

27. Contraindications • The contraindications to IABP are summarized in Table. It is contraindicated in patients with aortic regurgitation because it worsens the magnitude of regurgitation. • IABP insertion should not be attempted in case of suspected or known aortic dissection because inadvertent balloon placement in the false lumen may result in extension of the dissection or even aortic rupture.

28. Table

29. Similarly, aortic rupture can occur if IABP is inserted in patients with sizable abdominal aortic aneurysms. Patients with end-stage cardiac disease should not be considered for IABP unless as a bridge to ventricular assist device or cardiac transplantation. • IABP device placement should be avoided in patients with severe peripheral vascular disease. Percutaneous femoral IABP device insertion is contraindicated in the presence of bilateral femoral–popliteal bypass grafts. Uncontrolled sepsis and bleeding diathesis are relative contraindications to the placement of IABP device.

30. Nursing care of patients during intraaortic balloon pumping • Caring for patients with intraaortic balloon pumps (IABPs) is a unique nursing challenge in the cardiovascular recovery and intensive care units. • The primary purpose of IABP is the support of the failing heart by simultaneously increasing myocardial oxygen supply and decreasing myocardial oxygen demand.

31. Briefly, the intraaortic balloon pump is a specific and aggressive form of care for patients in cardiogenic shock. • In-depth physiologic principles that involve a sound understanding of cardiovascular complications, with indications for physiologic and psychologic interventions, are necessary to aid the nurse during this critical period. • Moreover the cardiovascular nurses caring for these patients require skills and knowledge that enable prompt recognition and treatment of sometimes life-threatening complications associated with balloon pump therapy.

32. Briefly, the intraaortic balloon pump is a specific and aggressive form of care for patients in cardiogenic shock. • From the experience acquired in the treatment of cardiogenic shock and in the use of the IABP, it has emerged the unavoidable need to resort as soon as possible to IABP and intensive care to avoid multi-organ damages highly associated to mortality. • The ICU nursing professional, who works with more and more sophisticated technologies and devices, has always to be acquainted with current literature, in order to ensure a better nursing care and to reduce complications.

33. References • http://www.texasheart.org/Research/Devices/iabp.cfm • https://www.webmd.com/heart-disease/tc/intra-aortic-balloon-pump-topic-overview • https://academic.oup.com/bjaed/article/9/1/24/466259 • https://www.hopkinsmedicine.org/healthlibrary/test_procedures/cardiovascular/intra-aortic_balloon_pump_therapy_135,341 • M.Bayoumi, Nursing care of patients during intraaortic balloon pumping, Journal of the Saudi Heart Association, Volume 27, Issue 4, October 2015, Pages 318-319