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The Intra-aortic balloon pump (IABP) is a mechanical device that is used to increase myocardial oxygen supply and decrease myocardial oxygen demand as well as increase cardiac output. It consists of a cylindrical balloon that sit in the aorta and actively deflates in systole increasing forward blood flow by reducing afterload, and actively inflates in diastole increasing blood flow to the coronary arteries. Intensive Care Medicine by Irwin and Rippe Intra Aortic Balloon Pump (IABP) Counterpulsation mirror with better quality by P. J Overwalder, M.D., Department of Surgery, Division of Cardiac Surgery, University Hospital Graz, The Internet Journal of Thoracic and Cardiovascular Surgery. 1999. Volume 2 Number 2. Intra-aortic balloon pumping Department of Anaesthesia and Intensive Care of The Chinese University of Hong Kong
History
The IABP device was pioneered at the Cleveland Clinic during the early 1960's by Moulopoulus et al.
Use of counterpulsation
Indications
The following situations may benefit from this device.
- Cardiogenic shock when used alone as treatment for myocardial infarction 9-22% survive the first year.
- Reversible intracardial mechanical defects complicating infarction, i.e. acute mitral regurgitation and septal perforation.
- Unstable angina pectoris benefits from counterpulsation.
- Postcardiothoracic surgery most common and useful is the use of counterpulsation in weaning patients from cardiopulmonary bypass after continued perioperative injury to myocardial tissue.
- Preoperative use has been suggested for high-risk patients such as those with unstable angina with stenosis greater than 70% of main coronary artery, in ventricaular dysfunction with an ejection fraction less than 35%.
- Bridge to heart transplant for those patients with left ventricular failure.
- Percutaneous coronary angioplasty
Contraindications
Absolute contraindication
The following conditions will always exclude patients for treatment:- Aortic valve insufficiency
- Aortic dissection
- Severe aortoiliac occlusive disease
Relative contraindication
The following conditions could, under very pressing circumstances, be allowed to be included for therapy:Complications
Since the device is placed in the femoral artery and aorta it could provoke ischemia. Most notably the leg which is supplied by the femoral artery may become ischemic, but also placing the balloon too distal from the arcus aortae may induce occlusion of the renal artery and subsequent renal failure. Other possible complications are cerebral embolism during insertion, infection, dissection of the aorta or iliac artery, perforation of the artery and hemorrhage in the mediastinum.
See also
References
External links
- Intra-aortic Balloon Pump (IABP) Texas Heart Institute
- Intra Aortic Balloon Pump (IABP) two videos demonstrating inflating and deflating the balloon
- Images in cardiovascular medicine The missing intra-aortic balloon pump catheter by Pasquale Totaro, Nello Degno, John Smith, Vincenzo Argano, Cardiac Surgery Department, Regional Cardiac Center, Morriston Hospital, Swansea, UK, Ital Heart J 2005; 6 (4): 361-362)
"Intra-aortic balloon pump"