2. When to use this !
Ongoing ischemia refractory to medical therapy.
Prophylactic placement for high-risk patients with critical coronary
disease
High-risk patients undergoing off-pump surgery to maintain
hemodynamic stability during lateral wall or posterior wall grafting.
Unloading for cardiogenic shock or mechanical complications of
myocardial infarction (acute mitral regurgitation, ventricular septal
rupture).
3. Postcardiotomy low cardiac output syndrome unresponsive to
moderate doses of multiple inotropic agents.
Postoperative myocardial ischemia.
Acute deterioration of myocardial function to provide temporary
support or serve as a bridge to transplantation.
4. *2 Primary Benefits of IABP
The primary purpose of the IABP is to increase Coronary
Oxygen Supply during Diastole.
The next purpose of the IABP is to Decrease Coronary
Oxygen Demand during Systole.
23. Relative Contraindications
• End-Stage Cardiomyopathy in a patient not
a candidate for transplant
• End-stage Terminal Disease
• Abdominal Aortic Aneurysms, not resected
28. In nearly all circumstances the IABP will be inserted via the Femoral
Artery.
29. Pre-Insertion Assessment
1. Skin color of both legs
2. Skin temperature of both legs
3. Capillary refill ability of both legs
4. Quality of pulses in both arms & legs
5. Baseline sensation and movement of both legs
6. Complete neuro check
40. When inflation timing is correct there
should be a sharp “V” shape at the
dicrotic notch.
41. Augmentation should be higher than
PSP unless:
1. Patient’s SV significantly greater than
balloon volume
2. Balloon is positioned too low
3. Hypovolemia
4. Balloon is too small
5. Improper timing
6. Partial obstruction of gas flow
PSP AUG
70. Fill Failure
Pump did not fill adequately with helium to establish the
balloon pressure waveform baseline
Verify helium tank not empty, all catheter connections
intact
76. FOR GOOD, CONSISTANT TRIGGERING IT IS IMPORTANT TO
PROVIDE THE PUMP WITH A GOOD ECG SIGNAL
Good Choices –
Unidirectional QRS with minimal
artifact
Poor Choices –
Biphasic QRS, tall T or P waves, wandering baseline, artifact
present
77. This lead will give you both
triggering and timing problems
78. ECG
Newer Systems will automatically initiate
Arrhythmia Timing when several irregular
diastolic intervals occur.
Arrhythmia Timing allows for more
consistent and appropriate deflation of the
IAB during irregular rhythms.
81. Arterial Trigger
The IABP will detect changes in arterial pressure to
initiate inflation and deflation.
It is the trigger of choice when CPR is in progress.
82. Internal
The balloon inflates and deflates at a
preset rate regardless of the patient’s
cardiac activity.
This mode is only to be used when there
is no cardiac output and no ECG but
many newer systems can detect pressure
differences from CPR
85. Augmentation refers to how full we fill the IABP balloon
during operation.
During normal operation the IABP will be operated at
100% augmentation
The IABP should never be operated below 50%
augmentation.
86. Low augmentation can result in the peak diastolic
augmentation being lower than unassisted systole and
the wave form will look irregular.
Augmentation is frequently used in conjunction with
timing to wean the patient from the IABP.
88. Balloon Rupture
Balloon Rupture can allow a large gas embolism to enter the body.
The IABP must never be operated if a Balloon rupture is suspected.
89. The classic sign of a balloon rupture is rust colored specs inside the
IABP helium tubing in conjunction with loss of helium pressure.
It the rupture is large it may be RED.
91. Transducer Position
The transducer should be placed in line with the phlebostatic axis.
During transport it is critical that the transducer be secured at a fixed
point on the patient.
92. For every inch variance to the phlebostatic axis there is a 2 mm/HG
inverse change in pressure.
Increase height by 4 inches and pressure reads 8 mm/HG lower
93. All of the transducer connections must be tight to prevent rapid
blood loss.
There must not be any air in the transducer lines.
95. weaning
IABP support can be withdrawn when the cardiac output is satisfactory
on minimal inotropic support (usually 1 mg/min of epinephrine or 5
mg/kg/min of either dopamine or dobutamine). However, earlier
removal may be indicated if complications develop, such as leg
ischemia, balloon malfunction, thrombocytopenia, or infection.
96. weaning
Weaning is initiated by decreasing the inflation ratio from 1:1 to 1:2
for about 2– 4 hours, and then to 1:3 or 1:4 for 1–2 more hours.
Once it is determined that the patient can tolerate a low inflation
ratio with stable hemodynamics, the IABP should be removed.
If there is an anticipated delay in removal of more than a few hours
for manpower reasons or because of the need to correct a
coagulopathy, the ratio should be increased to at least 1:2 to
prevent thrombus formation.