Intraaortic Baloon Counterpulsation

1. Intra-aortic balloon counterpulsation (IABCP) DR. SHERIF BADRAWY

2. IABP has two parts ? 1a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy Digitally signed by Dr.Sherif Badrawy Date: 2015.11.11 16:26:25 +03'00'

3. ☆ catheter with a long sausage- shaped balloon at the distal tip ☆ a pump that inflates the balloon 1b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

4. balloon volumes 2a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

5. about 30-50 mL filled with helium when inflated fill 80-90% of the aorta 2b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

6. Function of IABCP ? 3a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

7. ☆ Balloon inflation during diastole augments DBP ➜ displaces blood proximally and distally ➜ ⇧systemic and coronary perfusion ☆ balloon deflation decreases afterload during systole ➜ ⇩myocardial oxygen demand 3b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

8. Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

9. Balloon inflation in early diastole usually triggered by ? 4a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

10. the R wave on the ECG 4b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

11. Pt developed AF, how IABCP will be triggered ? 5a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

12. ☆ IABP cannot be successfully triggered using the R waves in AF. ☆ pacing spikes or the arterial blood pressure waveform may used for triggering ☆ pump can be set at an intrinsic rate without any physiological triggering. ☆ the patient remains HD stable despite the IABP malfunctioning ➜ REMOVE IT. 5b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

13. IABCP Used in ? 6a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

14. pump failure if may resolve spontaneously, or a corrective procedure is planned. 6b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

15. indications for IABP ? 7a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

16. ☆ Cardiogenic shock, after CABG, acute MI. ☆ Acute MR ☆ Planned cardiac transplant ☆ V arrhythmias refractory toRx ☆ cardiotoxicity from poisoning, e.g. verapamil 7b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

17. Insertion technique for IABP ? 8a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

18. ☆ Seldinger technique ☆ Fluoroscopy is not essential ☆ femoral artery ☆ proximal descending aorta. ☆ tip just distal to the origin of the left subclavian artery ☆ entire balloon lie above the renal AA ☆ position should be checked on CXR ☆ if D/C sheath must be removed first 8b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

19. Contra-indications for IABP ? 9a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

20. ☆ AR, Aortic dissection ☆ PDA ☆ Severe peripheral vascular disease ☆ Thoracic aortic graft <12 months old ☆ cardiac index is too low for there to be a clinical benefit from IABP assistance 9b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

21. IABP efficiency is determined by 10a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

22. ☆ Timing of balloon inflation and deflation Assist ratio (1:1 - balloon inflation & deflation with cardiac cycle ➜ > circulatory assistance than 1:2 or 1:4 - balloon inflation and deflation on every 2nd or 4th cardiac cycle ) ☆ Heart rate (⇩efficiency at HR >130/min) ☆ balloon volume ☆ Minimum CI of 1.2 - 1.4 L/min/m2 required for IABP to be clinically beneficial. 10b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

24. Optimisation of IABPs? 11a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

25. ☆ inflation at the dicrotic notch (forming the sharp 'V') ☆ the slope of rise of augmented diastolic waveform is straight and parallel to the systolic upstroke ☆ the augmented DBP at balloon deflation exceeds or is equal to end-systolic BP ☆ the end-diastolic BP at balloon deflation is lower than the preceding unassisted end-DBP by 15- 2 mmHg ☆ the assisted SBP (following a cycle of balloon inflation) is lower than the previous unassisted SBP by 5 mmHg 11b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

27. complications of IABPs? 12a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

28. ☆ failure to insert ☆ aortic dissection and arterial perforation ➜ retroperitoneal Hge ☆ LL Ischemia ☆ Catheter-related ☆ Balloon rupture ➜ helium embolus (key indicator of balloon rupture is blood in the connecting tubing) ☆ Hemolysis and consumptive thrombocytopenia ☆ Peripheral neuropathy 12b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

29. IABP weaning & removal: 13a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

30. • Decrease inotropic support • Decrease IABP ratio • Discontinue heparin(+ platelet transfusion?) • Deflate balloon • Remove balloon while alternating pressure above and below insertion site to expel clots • Apply constant pressure to insertion site at least 30 min 13b Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

40. IABCP Troubleshooting Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy

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