<ul><li>Has a linear relationship to: </li></ul><ul><ul><li>Systolic wall stress </li></ul></ul><ul><ul><li>Intraventricul...
 
<ul><li>Cardiac failure after a cardiac surgical procedure </li></ul><ul><li>Refractory angina despite maximal medical man...
<ul><li>Severe aortic insufficiency </li></ul><ul><li>Aortic aneurysm </li></ul><ul><li>Aortic dissection </li></ul><ul><l...
<ul><li>The end of the balloon should be just distal to the takeoff of the left subclavian artery </li></ul><ul><li>Positi...
<ul><li>Electrocardiographic </li></ul><ul><li>Arterial pressure tracing </li></ul>
<ul><li>Inflation of the IAB prior to aortic valve closure. </li></ul><ul><li>Waveform Characteristics: </li></ul><ul><li>...
<ul><li>Inflation of the IAB markedly after closure </li></ul><ul><li>of the aortic valve. </li></ul><ul><li>Waveform Char...
<ul><li>Premature deflation of the IAB during the diastolic phase. </li></ul><ul><li>Waveform Characteristics: </li></ul><...
<ul><li>Late deflation of the IAB during the diastolic phase. </li></ul><ul><li>Waveform Characteristics: </li></ul><ul><l...
<ul><li>Arterial pressure waveforms </li></ul>
 
<ul><li>Limb ischemia </li></ul><ul><ul><li>Thrombosis </li></ul></ul><ul><ul><li>Emboli </li></ul></ul><ul><li>Bleeding a...
<ul><li>Timing of weaning </li></ul><ul><ul><li>Patient should be stable for 24-48 hours </li></ul></ul><ul><li>Decreasing...
<ul><li>Discontinue heparin six hours prior </li></ul><ul><li>Check platelets and coagulation factors </li></ul><ul><li>De...
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-7181622

  1. 2. <ul><li>Has a linear relationship to: </li></ul><ul><ul><li>Systolic wall stress </li></ul></ul><ul><ul><li>Intraventricular pressure </li></ul></ul><ul><ul><li>Afterload </li></ul></ul><ul><ul><li>End diastolic volume </li></ul></ul><ul><ul><li>Wall thickness </li></ul></ul>
  2. 4. <ul><li>Cardiac failure after a cardiac surgical procedure </li></ul><ul><li>Refractory angina despite maximal medical management </li></ul><ul><li>Cardiogenic shock </li></ul><ul><li>Mitral regurgitation </li></ul><ul><li>Perioperative treatment of complications due to myocardial infarction </li></ul><ul><li>Failed PTCA </li></ul><ul><li>As a bridge to cardiac transplantation </li></ul>
  3. 5. <ul><li>Severe aortic insufficiency </li></ul><ul><li>Aortic aneurysm </li></ul><ul><li>Aortic dissection </li></ul><ul><li>Limb ischemia </li></ul><ul><li>Thromboembolism </li></ul>
  4. 6. <ul><li>The end of the balloon should be just distal to the takeoff of the left subclavian artery </li></ul><ul><li>Position should be confirmed by fluoroscopy or chest x-ray </li></ul>
  5. 7. <ul><li>Electrocardiographic </li></ul><ul><li>Arterial pressure tracing </li></ul>
  6. 8. <ul><li>Inflation of the IAB prior to aortic valve closure. </li></ul><ul><li>Waveform Characteristics: </li></ul><ul><li>Inflation of IAB prior to dicrotic notch. </li></ul><ul><li>Diastolic augmentation encroaches onto systole, (may be unable to distinguish). </li></ul><ul><li>Physiologic effects: </li></ul><ul><li>Potential premature closure of the aortic valve. </li></ul><ul><li>Potential increase in LVEDV and LVEDP. </li></ul><ul><li>Increased left ventricular wall stress or afterload. </li></ul><ul><li>Aortic regurgitation. </li></ul><ul><li>Increased MV02 demand. </li></ul>
  7. 9. <ul><li>Inflation of the IAB markedly after closure </li></ul><ul><li>of the aortic valve. </li></ul><ul><li>Waveform Characteristics: </li></ul><ul><li>Inflation of IAB after the dicrotic notch. </li></ul><ul><li>Absence of sharp V. </li></ul><ul><li>Physiologic Effects: </li></ul><ul><li>Sub-optimal coronary artery perfusion. </li></ul>
  8. 10. <ul><li>Premature deflation of the IAB during the diastolic phase. </li></ul><ul><li>Waveform Characteristics: </li></ul><ul><li>Deflation of IAB is seen as a sharp drop following diastolic augmentation. </li></ul><ul><li>Sub-optimal diastolic augmentation. </li></ul><ul><li>Assisted aortic end diastolic pressure may be <= the unassisted aortic end diastolic pressure. </li></ul><ul><li>Assisted systolic pressure may rise. </li></ul><ul><li>Physiologic Effects: </li></ul><ul><li>• Sub-optimal coronary perfusion. </li></ul><ul><li>• Potential for retrograde coronary and carotid blood flow. </li></ul><ul><li>Sub-optimal after load reduction & Increased MV02 demand. </li></ul>
  9. 11. <ul><li>Late deflation of the IAB during the diastolic phase. </li></ul><ul><li>Waveform Characteristics: </li></ul><ul><li>Assisted aortic end diastolic pressure may be equal to the unassisted aortic end diastolic pressure. </li></ul><ul><li>Rate of rise of assisted systole is prolonged. </li></ul><ul><li>Diastolic augmentation may appear widened. </li></ul><ul><li>Physiologic Effects: </li></ul><ul><li>Afterload reduction is essentially absent. </li></ul><ul><li>Increased MV02 consumption due to </li></ul><ul><li>the left ventricle ejecting against a </li></ul><ul><li>greater resistance </li></ul><ul><li>IAB may impede left ventricular ejection and increase the afterload </li></ul>
  10. 12. <ul><li>Arterial pressure waveforms </li></ul>
  11. 14. <ul><li>Limb ischemia </li></ul><ul><ul><li>Thrombosis </li></ul></ul><ul><ul><li>Emboli </li></ul></ul><ul><li>Bleeding and insertion site </li></ul><ul><ul><li>Groin hematomas </li></ul></ul><ul><li>Aortic perforation and/or dissection </li></ul><ul><li>Renal failure and bowel ischemia </li></ul><ul><li>Neurologic complications including paraplegia </li></ul><ul><li>Heparin induced thrombocytopenia </li></ul><ul><li>Infection </li></ul>
  12. 15. <ul><li>Timing of weaning </li></ul><ul><ul><li>Patient should be stable for 24-48 hours </li></ul></ul><ul><li>Decreasing inotropic support </li></ul><ul><li>Decreasing pump ratio </li></ul><ul><ul><li>From 1:1 to 1:2 or 1:3 </li></ul></ul><ul><li>Decrease augmentation </li></ul><ul><li>Monitor patient closely </li></ul><ul><ul><li>If patient becomes unstable, weaning should be immediately discontinued </li></ul></ul>
  13. 16. <ul><li>Discontinue heparin six hours prior </li></ul><ul><li>Check platelets and coagulation factors </li></ul><ul><li>Deflate the balloon </li></ul><ul><li>Apply manual pressure above and below IABP insertion site </li></ul><ul><li>Remove and alternate pressure to expel any clots </li></ul><ul><li>Apply constant pressure to the insertion site for a minimum of 30 minutes </li></ul><ul><li>Check distal pulses frequently </li></ul>

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