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Intraaortic Baloon Counterpulsation
Intra-aortic balloon counterpulsation (IABP) is a mechanical device that augments cardiac output by inflating and deflating a balloon in the aorta, thereby improving systemic and coronary perfusion while reducing myocardial oxygen demand. It is indicated for conditions such as cardiogenic shock and acute myocardial infarction, with insertion typically using the Seldinger technique. Key considerations include contraindications, optimization measures for efficiency, potential complications, and protocols for weaning and removal.
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Intraaortic Baloon Counterpulsation
- 1. Intra-aortic balloon counterpulsation (IABCP) DR.SHERIF BADRAWY
- 2. IABP has twoparts ? 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 witha 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 BaloonCounter Pulsation Dr.Sherif Badrawy
- 5. about 30-50 mL filledwith 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 inflationduring 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 CounterPulsation Dr.Sherif Badrawy
- 9. Balloon inflation inearly diastole usually triggered by ? 4a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy
- 10. the R waveon 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 cannotbe 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 ifmay 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 forIABP ? 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, Aorticdissection ☆ 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 isdetermined by 10a Intraaortic Baloon Counter Pulsation Dr.Sherif Badrawy
- 22. ☆ Timing ofballoon 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
- 23. Intraaortic Baloon CounterPulsation Dr.Sherif Badrawy
- 24. Optimisation of IABPs? 11a IntraaorticBaloon Counter Pulsation Dr.Sherif Badrawy
- 25. ☆ inflation atthe 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
- 26. Intraaortic Baloon CounterPulsation Dr.Sherif Badrawy
- 27. complications of IABPs? 12a IntraaorticBaloon Counter Pulsation Dr.Sherif Badrawy
- 28. ☆ failure toinsert ☆ 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 inotropicsupport • 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
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- 40. IABCP Troubleshooting Intraaortic BaloonCounter Pulsation Dr.Sherif Badrawy
- 41. Intraaortic Baloon CounterPulsation Dr.Sherif Badrawy
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