The intra-aortic balloon pump (IABP) provides counterpulsation by inflating during diastole to boost blood flow to the coronaries and deflating during systole to reduce afterload and increase cardiac output. It is indicated for cardiogenic shock, intractable angina, and low cardiac output after CABG. The IABP monitors aortic pressure and aims for a 30-70% increase in diastolic pressure during augmentation. Complications include thrombosis, embolism, infection, and vascular injury. Proper timing of inflation and deflation is important to provide benefits and avoid increased afterload and oxygen consumption.

1. IABP
.

2. Intra aortic balloon pumb
• What is it ?

3. Possition
• 2cm distal to the subclavian artery exit on the left to above the renal
artery.

4. What counter pulsation means
• Inflation during diastole and deflation during systole

5. Function
• Inflation boosts the blood flow to the coronaries
• Deflation decreases the afterload thus augments the CO.

6. As a result,what will be the indications?
Cardiogenic shock
Intractable angina(eg in cath lab,post surgery)
Low co after CABG …explain ?

7. .the transducer
• Measures the aortic pressure

8. Augmentation
• The peak of the diastolic augmentation should be higher than the
systolic pressure by 30% to 70%.

9. What are the causes of little augmentation
pressure .
Possition
Volume of the filling Gass
Small size
Membrane is not unfolded
Low blood volume
Tachycardia
vasodilatation

10. .
• Triggering
• The console need to know when to start work
• 1. ECG : the console can detect the R wave which preceed the
mechanical systole by short time…best
• 2 .aortic pressure curve less valuable as as it detect the event of
systole and diastole when it occurs.

11. Triggering difficulties
• In arrhythmias : the best treatment is to treat arrhythmia
• If not use another trigger .
• How fast can we fully support the circulation and what full support
means .
• Up to 150 (traditionally)
• If more use 1:2 support not full support ie 1:1

12. Weaning
• By decreasing the number of assisted beats eg 1:1 ;1:2 ;1:3;1:4
• Or by decreasing the volume of the inflation gas
• What do you look at to detect successful weaning ?
• Answer:
• Perfusion parameters

13. Access site
• Femoral common ..with or without a sheeth
• Subclavian …how to know the proper position in xray?
• AORTIC DURING SURGERY …WHEN ?

14. CONTRAINDICATIONS
• Aortic regurge
• Aortic diseases

15. complications
• Thrombosis
• Embolism
• Infection
• Thrombocytopenia
• Injury to the vessels…bleeding

16. Follow complications..
• Inproper timing
• Normally deflation happens in diastole at the time of aortic valve
closure
• On the aortic curve this is opposite the diacrotic notch
• On studying the timing there should be 1:2 augmentation the two
diacrotic notches at the same level actually that on the beat without
diastolic augmentation is slightly lower
• Normally the diastolic augmentation forms a sharp V shape with the
descending limb of the aortic pressure curve

17. .early inflation
• In early inflation ie inflation happens early and cause the aortic valve
to close earlier while the ventricle is still contracting causing an
increased wall tension and more ischemia.

18. Late inflation …(for memorising :net result
short period inflation).
• Will see the dicrotic notch then a distance and the augmentation
after
• Decresing the diastolic augmentation and its benifits

19. Deflation
• Normally happens at the onset of systole …at the isometric
contraction phase
• The normally the assisted end diastolic pressure is lower than the
patient ‘s diastolic at the angle of sharp V like wave too

20. Late deflation ..(remember inflation is long )
• The ballon remain inflated during part of the systole so so after load is
increased and oxygen consumption
• Diagnosis..
• Unassisted diastole is lower than the assisted end diastolic pressure
• Broad diastolic augmentation

21. .early deflation (shorter duration )
• Deflation before the end of systole
• Lesser benefits
• -ve pressure creation during diastole …coronary steal
• The assisted systolic pressure not lower than the unassisted
• May see the U shapeat the assisted end diastolic pressure.
• The wave after the diastolic augmentation will show sharp drop

22. Automated mode
• Currently available so usually no need for adjustment for the inflation
and deflation time.
• If you feel you must adjust ..change to semiauto mode 2:1
augmentation and look at the radial curve which can be displayed on
recent balloon screens.

23. What is the evidence behind the use of IABP
• Search …..