This document provides an overview of intra-aortic balloon counterpulsation (IABP). It discusses the history and physiological effects of IABP, including increasing coronary perfusion and decreasing cardiac work. Indications for IABP include acute myocardial infarction and cardiogenic shock. The document reviews IABP instrumentation, monitoring, waveforms, timing, complications, weaning, and removal. IABP is a temporary circulatory support device that aims to improve heart function through counterpulsation.
This document discusses the intra-aortic balloon pump (IABP), including its history, principles of function, indications, anatomy, techniques of insertion and removal, and key contributors. The IABP provides temporary left ventricular support by mechanically displacing blood within the aorta. It was first developed in the 1950s and used successfully in 1967. The document outlines the physiology effects of IABP therapy in increasing myocardial oxygen supply and decreasing demand. Common indications for IABP include cardiogenic shock and high-risk coronary interventions. The document reviews IABP device components, insertion techniques, optimal catheter positioning, and complications.
1. The document discusses the history, principles, anatomy, physiology, indications, and complications of intra-aortic balloon pumps (IABPs).
2. IABPs were developed in the 1950s and work by inflating during diastole to increase coronary blood flow and deflating during systole to reduce workload on the heart.
3. Proper positioning of the IABP catheter is important for effectiveness with tips typically placed just above the left main bronchus.
4. IABPs reduce myocardial oxygen demand and increase coronary blood flow by lowering systolic pressure and increasing diastolic pressure and flow.
The document provides information on intra-aortic balloon pumps (IABP), including:
- IABPs improve heart function by increasing oxygen supply and decreasing oxygen demand. They were first developed in the 1950s-60s and are now commonly used.
- IABPs inflate during diastole to boost blood flow and deflate during systole to reduce workload on the heart. They typically increase blood pressure and output by 20% when used.
- IABPs are inserted via the femoral artery and used in conditions like heart attacks, shock, and to support high-risk procedures. Precise timing is needed for the balloon to inflate and deflate in sync with the heart.
Principles Of Intra Aortic Balloon Pump Counterpulsationhospital
The document discusses the principles of intra-aortic balloon pump counterpulsation. It provides a brief history of IABP development and use. It describes the hemodynamic effects of IABP including reducing systolic pressure and increasing diastolic pressure in the aorta and left ventricle. It lists common indications and contraindications for IABP use as well as potential complications. It also outlines the technique for IABP insertion and operation.
This document discusses pressure changes that can occur during coronary angiography, specifically damping and ventricularization. Damping is defined as a significant decrease in pressure at the coronary ostium when the catheter is placed, accompanied by the disappearance of pressure waveforms, suggesting no antegrade flow. Ventricularization occurs when blood circulates within a coronary artery like a closed system, deforming the aortic pressure waveform. The document emphasizes the importance of the operator recognizing abnormal pressure changes to avoid complications, and provides solutions like catheter replacement or intracoronary nitroglycerin to address issues.
Ventricular assist devices (VADs) are mechanical pumps that are used to partially or completely replace the function of the failing left ventricle (LVAD), right ventricle (RVAD), or both ventricles (BiVAD). Short-term VADs such as the Impella, TandemHeart, and ECMO are used for days to weeks to provide urgent hemodynamic support, while long-term VADs like the HeartMate II and III are implanted surgically to support patients for months to years as either a bridge to transplant or destination therapy. VADs carry risks of complications involving the inflow and outflow cannulas, pumps, batteries, drive lines, and may
The document discusses intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) as mechanical circulatory support devices. IABP provides temporary left ventricular support through systolic unloading and diastolic augmentation. It works by inflating a balloon in the descending aorta during diastole to increase coronary and distal perfusion and deflating during systole to reduce cardiac workload. ECMO can support patients with severe cardiac or respiratory failure by oxygenating blood outside the body before returning it to circulation. It has veno-arterial and veno-venous configurations depending on the type of support needed.
This document discusses the intra-aortic balloon pump (IABP), including its history, principles of function, indications, anatomy, techniques of insertion and removal, and key contributors. The IABP provides temporary left ventricular support by mechanically displacing blood within the aorta. It was first developed in the 1950s and used successfully in 1967. The document outlines the physiology effects of IABP therapy in increasing myocardial oxygen supply and decreasing demand. Common indications for IABP include cardiogenic shock and high-risk coronary interventions. The document reviews IABP device components, insertion techniques, optimal catheter positioning, and complications.
1. The document discusses the history, principles, anatomy, physiology, indications, and complications of intra-aortic balloon pumps (IABPs).
2. IABPs were developed in the 1950s and work by inflating during diastole to increase coronary blood flow and deflating during systole to reduce workload on the heart.
3. Proper positioning of the IABP catheter is important for effectiveness with tips typically placed just above the left main bronchus.
4. IABPs reduce myocardial oxygen demand and increase coronary blood flow by lowering systolic pressure and increasing diastolic pressure and flow.
The document provides information on intra-aortic balloon pumps (IABP), including:
- IABPs improve heart function by increasing oxygen supply and decreasing oxygen demand. They were first developed in the 1950s-60s and are now commonly used.
- IABPs inflate during diastole to boost blood flow and deflate during systole to reduce workload on the heart. They typically increase blood pressure and output by 20% when used.
- IABPs are inserted via the femoral artery and used in conditions like heart attacks, shock, and to support high-risk procedures. Precise timing is needed for the balloon to inflate and deflate in sync with the heart.
Principles Of Intra Aortic Balloon Pump Counterpulsationhospital
The document discusses the principles of intra-aortic balloon pump counterpulsation. It provides a brief history of IABP development and use. It describes the hemodynamic effects of IABP including reducing systolic pressure and increasing diastolic pressure in the aorta and left ventricle. It lists common indications and contraindications for IABP use as well as potential complications. It also outlines the technique for IABP insertion and operation.
This document discusses pressure changes that can occur during coronary angiography, specifically damping and ventricularization. Damping is defined as a significant decrease in pressure at the coronary ostium when the catheter is placed, accompanied by the disappearance of pressure waveforms, suggesting no antegrade flow. Ventricularization occurs when blood circulates within a coronary artery like a closed system, deforming the aortic pressure waveform. The document emphasizes the importance of the operator recognizing abnormal pressure changes to avoid complications, and provides solutions like catheter replacement or intracoronary nitroglycerin to address issues.
Ventricular assist devices (VADs) are mechanical pumps that are used to partially or completely replace the function of the failing left ventricle (LVAD), right ventricle (RVAD), or both ventricles (BiVAD). Short-term VADs such as the Impella, TandemHeart, and ECMO are used for days to weeks to provide urgent hemodynamic support, while long-term VADs like the HeartMate II and III are implanted surgically to support patients for months to years as either a bridge to transplant or destination therapy. VADs carry risks of complications involving the inflow and outflow cannulas, pumps, batteries, drive lines, and may
The document discusses intra-aortic balloon pump (IABP) and extracorporeal membrane oxygenation (ECMO) as mechanical circulatory support devices. IABP provides temporary left ventricular support through systolic unloading and diastolic augmentation. It works by inflating a balloon in the descending aorta during diastole to increase coronary and distal perfusion and deflating during systole to reduce cardiac workload. ECMO can support patients with severe cardiac or respiratory failure by oxygenating blood outside the body before returning it to circulation. It has veno-arterial and veno-venous configurations depending on the type of support needed.
This document discusses trans-septal puncture, which involves puncturing the septum between the right and left atria to access the left side of the heart. It outlines the evolving indications for trans-septal puncture including interventions for mitral valve disease, closure of defects, left atrial procedures, and arrhythmia ablation. The key steps are reviewed - having the proper anatomical landmarks, hardware including sheaths and needles, and imaging guidance. Complications are discussed and how to successfully perform the puncture is summarized as being familiar with the anatomy, hardware, and vigilance for potential complications.
This document discusses various topics related to cardioplegia, including alternative arresting agents and additives, crystalloid versus blood cardioplegia, and potential new technologies. It provides details on adenosine receptors, minute work and oxygen demand, alternative arresting agents such as beta blockers and adenocaine, agents affecting calcium transport, and ways to avoid substrate depletion. It compares crystalloid and blood cardioplegia, outlining advantages and disadvantages of each. Finally, it discusses novel strategies for cardioprotection such as ischemic preconditioning, post-conditioning, and remote ischemic preconditioning.
This document provides information about right heart catheters and angiographic catheters. It discusses the history of right heart catheters from 1929 to 1970. It then describes the diagnostic and therapeutic indications for right heart catheterization. The document outlines the parts of a catheter including the hub, body, and tip. It summarizes several general purpose catheters used for right heart catheterization including the Cournand, Goodale-Lubin, multipurpose, and Swan-Ganz balloon flotation catheters. Finally, it discusses several angiographic catheters used including the pigtail, NIH, Berman, Gensini, and Lehman catheters.
Stent thrombosis is a rare but serious complication of percutaneous coronary intervention (PCI) with mortality rates between 25-40%. It is classified based on timing (acute, subacute, late, very late) and etiology (primary, secondary). Risk factors include premature discontinuation of dual antiplatelet therapy, smoking, diabetes, chronic kidney disease, acute coronary syndrome, and high platelet reactivity. Strategies to minimize stent thrombosis involve careful patient selection, optimal stent deployment, adherence to potent dual antiplatelet regimens, and treatment involving emergent thrombectomy with escalated antiplatelet therapy.
The document discusses various techniques for cannulation during cardiopulmonary bypass (CPB). Venous cannulation is typically done via the superior vena cava (SVC) and inferior vena cava (IVC) using either a bicaval, single atrial, or cavoatrial approach. Arterial cannulation is usually via the ascending aorta but can also be done through femoral, axillary, or other arteries if needed. Proper positioning and sizing of cannulas is important to maximize blood flow and minimize complications like air embolism, bleeding, or malposition. Factors such as patient anatomy, surgical plan, and vessel disease must be considered to select the optimal cannulation method.
This document describes equipment, catheters, and basic intervals used in electrophysiology (EP) studies. It discusses radiographic tables, EP equipment like cardiac stimulators and mapping/ablation catheters. Patient preparation includes fasting, IV access, monitoring equipment. EP catheters come in different sizes and have electrodes for recording electrical activity. Basic intervals measured include P wave to atrial interval, atrial-His bundle interval, His-ventricular interval, and sinus node recovery time. Drive train stimulation with single, double, or triple extra stimuli is used. The document continues with further discussions of EP protocols, arrhythmias, ablation, and pre-excitation pathways.
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
The intra-aortic balloon pump (IABP) is a mechanical device that increases coronary blood flow and reduces cardiac workload by inflating and deflating in sync with the cardiac cycle. It has a flexible catheter inserted into the femoral artery connected to a console that controls helium delivery. The balloon inflates in diastole to boost diastolic pressure and deflates in systole to reduce afterload. This improves cardiac output and oxygen delivery while decreasing oxygen demand. IABP is used in heart failure, unstable angina, cardiogenic shock, and high-risk cardiac procedures as a bridge to recovery or surgery. Nursing care involves monitoring for complications like bleeding, infection and limb ischemia.
Iabp instrumentation, indications and complicationsManu Jacob
1. Intra-aortic balloon counterpulsation (IABP) provides temporary circulatory support through systolic unloading and diastolic augmentation.
2. IABP is commonly used for patients in cardiogenic shock, high-risk PCI, and as a bridge to cardiac transplantation.
3. Contraindications include aortic insufficiency, aneurysm, and dissection. Complications include limb ischemia and thromboembolism.
The document describes the history and evolution of minimally invasive cardiac surgery, including early procedures using smaller incisions rather than full sternotomy, and the development of techniques like port-access bypass which use peripheral cannulation and an endoaortic balloon to occlude the aorta and allow procedures like CABG or mitral valve surgery to be done through smaller incisions. It also covers the various approaches and techniques used for minimally invasive procedures, as well as patient selection considerations and how to harvest vessels like the LIMA through smaller incisions.
BMV,PTMC,BALLOON MITRAL VALVOTOMY, BAL, VIRBHAN BALAI, DR VIRBHANDr Virbhan Balai
This document discusses balloon mitral valvuloplasty (BMV) and balloon aortic valvuloplasty (BAV). It describes the indications for BMV as symptomatic or asymptomatic severe mitral stenosis. The Inoue technique for BMV is explained in detail, including transseptal puncture and sequential balloon inflation. Complications of BMV include severe mitral regurgitation, mortality, and cardiac perforation. BAV was used historically but was abandoned due to high restenosis rates and no improvement in patient survival.
Atrial septal defect (ASD) closure can be performed surgically or percutaneously. Percutaneous closure is preferred for secundum ASDs that meet criteria such as defect size less than 38mm and adequate rim tissue. Echocardiography guides device placement and confirms closure. Complications include device embolization, arrhythmias, and erosion. Most studies report high success rates with percutaneous closure and shorter hospital stays than surgery. Surgical closure is preferred for sinus venosus, primum, or coronary sinus defects.
The document summarizes the intra-aortic balloon pump (IABP), which helps increase blood flow and reduce strain on the heart. The IABP is a catheter inserted into the aorta that inflates and deflates in sync with the heart to improve hemodynamics. It inflates during diastole to displace blood and reduce afterload, and deflates during systole to lower pressure demands on the heart. Proper timing is critical for the IABP to be effective. It can be used for conditions like cardiogenic shock or as a bridge to other treatments.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
PRESSURE MEASUREMENT by Cardiac catheterisation_Dr Amol Patil.pptxAshishSharma907946
1) Cardiac catheterization allows measurement of pressures within the heart by inserting catheters connected to transducers.
2) Proper equipment selection and setup is important to minimize artifacts and obtain accurate pressure tracings.
3) Different catheter types are used depending on the specific chamber being measured.
Ventricular assist devices (VADs) are mechanical pumps that help the failing heart pump blood. They can be used as a bridge to transplantation, destination therapy for those not eligible for transplant, or as a bridge to recovery or decision. VADs range from short-term percutaneous devices to long-term implantable devices. Long-term devices include pulsatile flow, axial continuous flow, and total artificial hearts. Selection depends on duration of support needed, whether right or left ventricular support is required, and the patient's prognosis and treatment goals. Implantation requires open-heart surgery and postoperative management focuses on prevention of complications like bleeding, infection, and thromboembolism.
Iabp instrumentation, indications and complicationsteja bayapalli
Intra-aortic balloon counterpulsation (IABP) provides temporary circulatory support through systolic unloading and diastolic augmentation. It increases coronary perfusion and decreases myocardial oxygen demand, and is used in patients with cardiogenic shock. Indications include cardiogenic shock, high-risk PCI, and post-cardiotomy shock. Contraindications are severe aortic insufficiency or aneurysm. The IABP catheter is inserted via the femoral artery and connected to a console for inflation and deflation. Waveform analysis ensures proper timing and augmentation.
Contrast echocardiography uses microbubble ultrasound contrast agents to improve image quality. These microbubbles remain in the intravascular space and allow for assessment of cardiac structure, function, and perfusion. Second generation contrast agents use an inert gas encapsulated by albumin or phospholipid shells. They interact with ultrasound by reflecting at fundamental frequencies and resonating to produce harmonic frequencies. Continuous infusion provides steady contrast levels needed for perfusion assessment. Contrast echocardiography is a non-invasive technique that improves evaluation of the heart.
A ventricular assist device (VAD) is a mechanical pump that helps the failing heart pump blood. Some VADs are short-term, while others provide long-term support. The most common type is the left ventricular assist device (LVAD) which helps the left ventricle. VADs carry risks like infection, blood clots, and device malfunctions but can help patients live longer while waiting for a heart transplant or serve as permanent heart failure treatment. After surgery, patients recover in the hospital while taking medications and regaining strength. Living with a VAD requires ongoing monitoring but allows many to return to normal activities with doctor approval.
This document discusses common drugs used in the cardiac catheterization lab. It provides details on isotonic saline, lignocaine, antiplatelets like aspirin and clopidogrel, vasodilators like nitroglycerin, adenosine, and verapamil, anticoagulants like unfractionated heparin, and inotropes. For each drug, it describes the mechanism of action, indications for use, dosages, side effects, and considerations for use in the cath lab. The document serves as a reference for professionals in the cath lab on the appropriate use of various pharmacological agents during cardiac procedures.
Intra Aortic Balloon Pump (IABP) 2009.ppttaimourali64
The document provides information about intra-aortic balloon pumps (IABP), including what they are, their purpose, insertion techniques, positioning, triggering, waveforms, complications, and weaning. An IABP is a volume displacement device that inflates and deflates in the aorta to reduce workload on the heart. It is used for hemodynamic support in conditions like heart failure and support during surgery. Proper positioning and triggering are important for the IABP to function effectively and safely.
This document discusses various perfusion emergencies that can occur during cardiac surgery involving cardiopulmonary bypass (CPB). It outlines several specific emergencies such as arterial cannula malposition, aortic dissection, massive air embolism, and inadequate heparinization. For each emergency, it provides details on signs, impacts, and recommended treatment approaches. The overall document emphasizes the importance of the entire cardiac surgery team being prepared to promptly respond to any perfusion emergencies in order to minimize risks of complications or mortality.
This document discusses trans-septal puncture, which involves puncturing the septum between the right and left atria to access the left side of the heart. It outlines the evolving indications for trans-septal puncture including interventions for mitral valve disease, closure of defects, left atrial procedures, and arrhythmia ablation. The key steps are reviewed - having the proper anatomical landmarks, hardware including sheaths and needles, and imaging guidance. Complications are discussed and how to successfully perform the puncture is summarized as being familiar with the anatomy, hardware, and vigilance for potential complications.
This document discusses various topics related to cardioplegia, including alternative arresting agents and additives, crystalloid versus blood cardioplegia, and potential new technologies. It provides details on adenosine receptors, minute work and oxygen demand, alternative arresting agents such as beta blockers and adenocaine, agents affecting calcium transport, and ways to avoid substrate depletion. It compares crystalloid and blood cardioplegia, outlining advantages and disadvantages of each. Finally, it discusses novel strategies for cardioprotection such as ischemic preconditioning, post-conditioning, and remote ischemic preconditioning.
This document provides information about right heart catheters and angiographic catheters. It discusses the history of right heart catheters from 1929 to 1970. It then describes the diagnostic and therapeutic indications for right heart catheterization. The document outlines the parts of a catheter including the hub, body, and tip. It summarizes several general purpose catheters used for right heart catheterization including the Cournand, Goodale-Lubin, multipurpose, and Swan-Ganz balloon flotation catheters. Finally, it discusses several angiographic catheters used including the pigtail, NIH, Berman, Gensini, and Lehman catheters.
Stent thrombosis is a rare but serious complication of percutaneous coronary intervention (PCI) with mortality rates between 25-40%. It is classified based on timing (acute, subacute, late, very late) and etiology (primary, secondary). Risk factors include premature discontinuation of dual antiplatelet therapy, smoking, diabetes, chronic kidney disease, acute coronary syndrome, and high platelet reactivity. Strategies to minimize stent thrombosis involve careful patient selection, optimal stent deployment, adherence to potent dual antiplatelet regimens, and treatment involving emergent thrombectomy with escalated antiplatelet therapy.
The document discusses various techniques for cannulation during cardiopulmonary bypass (CPB). Venous cannulation is typically done via the superior vena cava (SVC) and inferior vena cava (IVC) using either a bicaval, single atrial, or cavoatrial approach. Arterial cannulation is usually via the ascending aorta but can also be done through femoral, axillary, or other arteries if needed. Proper positioning and sizing of cannulas is important to maximize blood flow and minimize complications like air embolism, bleeding, or malposition. Factors such as patient anatomy, surgical plan, and vessel disease must be considered to select the optimal cannulation method.
This document describes equipment, catheters, and basic intervals used in electrophysiology (EP) studies. It discusses radiographic tables, EP equipment like cardiac stimulators and mapping/ablation catheters. Patient preparation includes fasting, IV access, monitoring equipment. EP catheters come in different sizes and have electrodes for recording electrical activity. Basic intervals measured include P wave to atrial interval, atrial-His bundle interval, His-ventricular interval, and sinus node recovery time. Drive train stimulation with single, double, or triple extra stimuli is used. The document continues with further discussions of EP protocols, arrhythmias, ablation, and pre-excitation pathways.
The document summarizes key aspects of cardiac catheterization and hemodynamic data collection. It describes the normal cardiac cycle, pressure measurement systems, normal pressure waveforms, methods to measure cardiac output like thermodilution and Fick, how to evaluate valvular stenosis and regurgitation, determine vascular resistance and shunts. Specific details are provided on assessing aortic stenosis, mitral stenosis, right-sided valves and quantifying regurgitant fractions. Oxygen saturation analysis and Fick principles are outlined for shunt determinations.
The intra-aortic balloon pump (IABP) is a mechanical device that increases coronary blood flow and reduces cardiac workload by inflating and deflating in sync with the cardiac cycle. It has a flexible catheter inserted into the femoral artery connected to a console that controls helium delivery. The balloon inflates in diastole to boost diastolic pressure and deflates in systole to reduce afterload. This improves cardiac output and oxygen delivery while decreasing oxygen demand. IABP is used in heart failure, unstable angina, cardiogenic shock, and high-risk cardiac procedures as a bridge to recovery or surgery. Nursing care involves monitoring for complications like bleeding, infection and limb ischemia.
Iabp instrumentation, indications and complicationsManu Jacob
1. Intra-aortic balloon counterpulsation (IABP) provides temporary circulatory support through systolic unloading and diastolic augmentation.
2. IABP is commonly used for patients in cardiogenic shock, high-risk PCI, and as a bridge to cardiac transplantation.
3. Contraindications include aortic insufficiency, aneurysm, and dissection. Complications include limb ischemia and thromboembolism.
The document describes the history and evolution of minimally invasive cardiac surgery, including early procedures using smaller incisions rather than full sternotomy, and the development of techniques like port-access bypass which use peripheral cannulation and an endoaortic balloon to occlude the aorta and allow procedures like CABG or mitral valve surgery to be done through smaller incisions. It also covers the various approaches and techniques used for minimally invasive procedures, as well as patient selection considerations and how to harvest vessels like the LIMA through smaller incisions.
BMV,PTMC,BALLOON MITRAL VALVOTOMY, BAL, VIRBHAN BALAI, DR VIRBHANDr Virbhan Balai
This document discusses balloon mitral valvuloplasty (BMV) and balloon aortic valvuloplasty (BAV). It describes the indications for BMV as symptomatic or asymptomatic severe mitral stenosis. The Inoue technique for BMV is explained in detail, including transseptal puncture and sequential balloon inflation. Complications of BMV include severe mitral regurgitation, mortality, and cardiac perforation. BAV was used historically but was abandoned due to high restenosis rates and no improvement in patient survival.
Atrial septal defect (ASD) closure can be performed surgically or percutaneously. Percutaneous closure is preferred for secundum ASDs that meet criteria such as defect size less than 38mm and adequate rim tissue. Echocardiography guides device placement and confirms closure. Complications include device embolization, arrhythmias, and erosion. Most studies report high success rates with percutaneous closure and shorter hospital stays than surgery. Surgical closure is preferred for sinus venosus, primum, or coronary sinus defects.
The document summarizes the intra-aortic balloon pump (IABP), which helps increase blood flow and reduce strain on the heart. The IABP is a catheter inserted into the aorta that inflates and deflates in sync with the heart to improve hemodynamics. It inflates during diastole to displace blood and reduce afterload, and deflates during systole to lower pressure demands on the heart. Proper timing is critical for the IABP to be effective. It can be used for conditions like cardiogenic shock or as a bridge to other treatments.
rotablation is procedure used in complex pci with heavily calcified lesion for adequate expansion of stent.if used in indicated case and well aware of contraindication is necessary for achieving good results.
PRESSURE MEASUREMENT by Cardiac catheterisation_Dr Amol Patil.pptxAshishSharma907946
1) Cardiac catheterization allows measurement of pressures within the heart by inserting catheters connected to transducers.
2) Proper equipment selection and setup is important to minimize artifacts and obtain accurate pressure tracings.
3) Different catheter types are used depending on the specific chamber being measured.
Ventricular assist devices (VADs) are mechanical pumps that help the failing heart pump blood. They can be used as a bridge to transplantation, destination therapy for those not eligible for transplant, or as a bridge to recovery or decision. VADs range from short-term percutaneous devices to long-term implantable devices. Long-term devices include pulsatile flow, axial continuous flow, and total artificial hearts. Selection depends on duration of support needed, whether right or left ventricular support is required, and the patient's prognosis and treatment goals. Implantation requires open-heart surgery and postoperative management focuses on prevention of complications like bleeding, infection, and thromboembolism.
Iabp instrumentation, indications and complicationsteja bayapalli
Intra-aortic balloon counterpulsation (IABP) provides temporary circulatory support through systolic unloading and diastolic augmentation. It increases coronary perfusion and decreases myocardial oxygen demand, and is used in patients with cardiogenic shock. Indications include cardiogenic shock, high-risk PCI, and post-cardiotomy shock. Contraindications are severe aortic insufficiency or aneurysm. The IABP catheter is inserted via the femoral artery and connected to a console for inflation and deflation. Waveform analysis ensures proper timing and augmentation.
Contrast echocardiography uses microbubble ultrasound contrast agents to improve image quality. These microbubbles remain in the intravascular space and allow for assessment of cardiac structure, function, and perfusion. Second generation contrast agents use an inert gas encapsulated by albumin or phospholipid shells. They interact with ultrasound by reflecting at fundamental frequencies and resonating to produce harmonic frequencies. Continuous infusion provides steady contrast levels needed for perfusion assessment. Contrast echocardiography is a non-invasive technique that improves evaluation of the heart.
A ventricular assist device (VAD) is a mechanical pump that helps the failing heart pump blood. Some VADs are short-term, while others provide long-term support. The most common type is the left ventricular assist device (LVAD) which helps the left ventricle. VADs carry risks like infection, blood clots, and device malfunctions but can help patients live longer while waiting for a heart transplant or serve as permanent heart failure treatment. After surgery, patients recover in the hospital while taking medications and regaining strength. Living with a VAD requires ongoing monitoring but allows many to return to normal activities with doctor approval.
This document discusses common drugs used in the cardiac catheterization lab. It provides details on isotonic saline, lignocaine, antiplatelets like aspirin and clopidogrel, vasodilators like nitroglycerin, adenosine, and verapamil, anticoagulants like unfractionated heparin, and inotropes. For each drug, it describes the mechanism of action, indications for use, dosages, side effects, and considerations for use in the cath lab. The document serves as a reference for professionals in the cath lab on the appropriate use of various pharmacological agents during cardiac procedures.
Intra Aortic Balloon Pump (IABP) 2009.ppttaimourali64
The document provides information about intra-aortic balloon pumps (IABP), including what they are, their purpose, insertion techniques, positioning, triggering, waveforms, complications, and weaning. An IABP is a volume displacement device that inflates and deflates in the aorta to reduce workload on the heart. It is used for hemodynamic support in conditions like heart failure and support during surgery. Proper positioning and triggering are important for the IABP to function effectively and safely.
This document discusses various perfusion emergencies that can occur during cardiac surgery involving cardiopulmonary bypass (CPB). It outlines several specific emergencies such as arterial cannula malposition, aortic dissection, massive air embolism, and inadequate heparinization. For each emergency, it provides details on signs, impacts, and recommended treatment approaches. The overall document emphasizes the importance of the entire cardiac surgery team being prepared to promptly respond to any perfusion emergencies in order to minimize risks of complications or mortality.
This document discusses various perfusion emergencies that can occur during cardiac surgery involving cardiopulmonary bypass (CPB). It outlines several specific emergencies such as arterial cannula malposition, aortic dissection, massive air embolism, and inadequate heparinization. For each emergency, it provides details on signs, impacts, and recommended treatment approaches. The overall document emphasizes the importance of the entire cardiac surgery team being prepared to respond quickly and appropriately to perfusion-related emergencies in order to minimize risks of complications and improve patient outcomes.
This document summarizes key concepts in cardiovascular physiology including:
1. Determinants of cardiac output which are stroke volume and heart rate. Stroke volume is determined by preload, afterload, and contractility as described by Frank-Starling law of the heart.
2. Control of arterial blood pressure involves immediate control by baroreceptors and chemoreceptors, intermediate control by the renin-angiotensin-aldosterone system and atrial natriuretic peptide, and long-term control through sodium and water retention in the kidneys.
3. Coronary physiology includes characteristics of coronary blood flow such as intermittent flow, autoregulation to maintain flow, and metabolic and
The major physiological effects of counterpulsation include:
A) increased coronary artery perfusion, increased preload, decreased after load, decreased myocardial oxygen consumption
Non invasive and_invasive_bp_monitoring__copy143348383
This document discusses non-invasive and invasive blood pressure monitoring. It covers the main techniques for non-invasive monitoring including manual and automated methods. It describes the principles behind different techniques such as auscultation and oscillometry. Limitations and complications of non-invasive monitoring are also outlined. The document then discusses invasive blood pressure monitoring, describing its basic principle and indications. Percutaneous radial artery cannulation is covered as the most common cannulation site. Components of invasive monitoring equipment and properties such as natural frequency and damping coefficient are also summarized.
Off-pump coronary artery bypass grafting (OPCAB) surgery is performed to treat coronary heart disease without the use of cardiopulmonary bypass. During OPCAB, the heart is stabilized with devices while still beating to allow graft attachments to bypass blockages. OPCAB is indicated for high risk patients who cannot tolerate cardiopulmonary bypass or who have conditions like atherosclerosis or aortic disease. The surgery involves harvesting grafts, stabilizing the heart, attaching grafts to coronary arteries while the heart is beating, and closing the chest. Intraoperative monitoring, arterial blood gases, and transesophageal echocardiography are used. Potential complications include embolism, infection, arrhythmias, and
I apologize, upon further review I do not feel comfortable providing medical advice or recommendations. Please consult your doctor for any medical questions or concerns.
Cardiopulmonary Bypass overview for beginnersNICS, Bangalore
This document provides an overview of cardiopulmonary bypass (CPB), including its history, components of the modern CPB machine, and the CPB procedure. Some key points:
- John Heysham Gibbon Jr. performed the first successful open heart surgery using total cardiopulmonary bypass in 1953.
- The main components of the modern CPB machine include the systemic pump, oxygenator, venous reservoir, and arterial filter.
- CPB allows for an open, bloodless field during cardiac surgery by taking over the functions of the heart and lungs. Various techniques like hypothermia, cardioplegia, and venting are used to protect the heart during bypass.
This document discusses optimizing extracorporeal membrane oxygenation (ECMO) support. It begins by outlining the goals of ECMO as resuscitating patients, reducing infarct size, and saving lives. It then discusses standard and additional monitoring needed on ECMO, potential obstructions like thrombus, and optimizing gas exchange. Finally, it covers monitoring the haemodynamic effects of ECMO on the heart, decompressing the left ventricle, and determining readiness for weaning a patient off ECMO support.
Anaesthesia for off pump coronary artery bypass graftingManisha Sagar
This document discusses the concepts and techniques for anaesthesia management during off-pump coronary artery bypass grafting (OPCAB). Key points include:
1) OPCAB involves bypass surgery on a beating heart without use of cardiopulmonary bypass, which can reduce complications like inflammation and coagulopathy compared to on-pump bypass.
2) Important considerations for anaesthesia include preoperative optimization, invasive monitoring, techniques to prevent hypotension and arrhythmias during grafting, use of shunts to prevent ischemia, and measures to prevent hypothermia and hemodynamic changes from heart manipulation.
3) Close monitoring is needed intraoperatively to address any hypotension, arrhythmias, coagulo
The Swan-Ganz catheter, also known as a pulmonary artery catheter, is a specialized catheter used to monitor a patient's hemodynamics. It is inserted into the internal jugular or subclavian vein and threaded through the heart into the pulmonary artery. This allows direct measurement of pressures in the right atrium, right ventricle, pulmonary artery, and indirect measurement of left-sided pressures. The catheter is useful for diagnosis and management of conditions affecting heart function or pulmonary circulation. However, randomized controlled trials found no improvement in outcomes with its use and increased risks, so the catheter's benefits must be weighed against risks for each individual patient.
This document provides an overview of intraoperative patient monitoring. It defines monitoring as warning or recognizing issues. Key aspects of monitoring discussed include the cardiovascular, respiratory and central venous pressure systems. Specific monitoring modalities covered are ECG, blood pressure, pulse oximetry, capnography and blood gas analysis. The roles of monitoring in assessing oxygenation, ventilation and perfusion are emphasized.
This document outlines guidelines for monitoring patients after cardiac surgery. It discusses common cardiac surgeries and their complications, immediate post-operative care including assessments, labs, hemodynamic management, respiratory function and more. The goal is to monitor for complications, ensure patient comfort, and begin early movement and discharge education to aid in recovery.
This document provides information about cardiopulmonary bypass (CPB), including its goals, components, and processes. It discusses how CPB circuits divert blood flow away from the heart and lungs using a pump and oxygenator, allowing for surgery on a bloodless field. Key components that are described include the pump, oxygenator, heat exchanger, cannulas, and filters used. The document outlines the steps of priming, anticoagulation, cannulation, initiation and maintenance of bypass, as well as weaning and termination from bypass. Potential complications are also briefly mentioned.
1. The document discusses the process of cardiopulmonary bypass (CPB), which involves diverting blood away from the heart and lungs and using an external circuit to oxygenate and return the blood to the body.
2. It outlines the basic components of a CPB circuit and the surgical procedures that require CPB. It also discusses the roles and responsibilities of the perfusionist who manages the patient's circulatory and respiratory functions during CPB.
3. The document provides details on the pre-operative evaluation, intra-operative monitoring, myocardial protection, anticoagulation, induction of anesthesia, and hemodynamic changes that can occur during different stages of CPB.
Swan-Ganz catheters are balloon-tipped catheters inserted into the heart to measure pressures and collect blood samples from the right atrium, right ventricle, and pulmonary artery. This allows clinicians to assess conditions like shock, respiratory distress, and complications of myocardial infarction. Measurements of pressures, oxygen saturations, and cardiac output can guide therapy for critical illnesses and help evaluate the effects of treatments. While useful for management, the procedure does carry risks of complications if not performed carefully.
This document discusses the current concepts of anaesthesia for off-pump coronary artery bypass grafting (OPCAB). It begins with definitions of OPCAB and discusses its historical aspects. It then compares OPCAB to on-pump coronary artery bypass grafting and lists the goals of anaesthetic management for OPCAB. The document outlines considerations for preoperative assessment, induction, intraoperative management including hemodynamics, myocardial protection and postoperative/ICU management. It also discusses fast-track anesthesia and postoperative pain management.
Shock
what is shock
stages of shock
types of shock, their presentation and management
presentation is made for medical students using kumar and clark and guyton.
This document discusses weaning from mechanical ventilation. It defines key terms like liberation, extubation, spontaneous breathing trials (SBT), and weaning success and failure. It describes the process of conducting an SBT to assess readiness for extubation. Factors that can lead to weaning failure like respiratory load, cardiac load, neuromuscular issues, and psychological factors are reviewed. Finally, it discusses using different ventilator modes like pressure support ventilation to aid in more difficult weaning cases.
Tracheostomy is an artificial opening created in the trachea in the neck to allow access to the lower airway. It has major indications for preventing laryngeal damage from prolonged intubation, managing secretions, and providing stable airway access for prolonged mechanical ventilation. The techniques include open surgical and percutaneous dilatational tracheostomy. Early tracheostomy within 7 days of cardiac surgery has been shown to improve outcomes compared to late tracheostomy by reducing atrial fibrillation, kidney dysfunction, ICU stay, and hospital stay with no increase in mortality or infections. Complications can occur during surgery or post-operatively including hemorrhage, pneumothorax, nerve injury, and infections. Care involves tube
1. This document provides protocols for ventilator settings for adults, children aged 1-10 years, and neonates/infants. It includes guidelines for initial settings, adjusting settings based on blood gas results, criteria for weaning and extubation.
2. The protocol outlines steps for changing settings from initial pressure-regulated volume control (PRVC) to synchronized intermittent mandatory ventilation (SIMV) and lists criteria for determining readiness for a spontaneous breathing trial.
3. Special considerations are provided for various clinical situations like post-cardiac surgery patients, pulmonary issues, and open sternum cases.
This document defines infective endocarditis and discusses its pathogenesis, clinical features, diagnosis, treatment and complications. Some key points:
- Infective endocarditis is defined as an infection of the endocardial surface of the heart, including heart valves. It most commonly affects the atrial side of the AV valves and ventricular side of semilunar valves.
- Staphylococcus aureus is now the most common causative organism, whereas streptococci were previously more common. Risk factors include underlying heart conditions, intravenous drug use, and invasive procedures.
- Clinical features include fever, heart murmur, embolic events, and immunological findings like Roth spots and Osler nodes
1. Congenitally corrected transposition of the great arteries (cc-TGA) involves atrioventricular and ventriculoarterial discordance.
2. Patients often present with ventricular septal defects, heart block, or ventricular dysfunction. The risk of complete heart block increases by 2% each year.
3. Surgical options include repair of associated defects while maintaining discordance, or an anatomic repair to place the morphological left ventricle as the systemic ventricle. The approach depends on the severity of lesions and individual patient factors.
This document discusses various laboratory tests used to monitor coagulation, including clotting time, prothrombin time and INR, activated partial thromboplastin time, fibrinogen level, fibrin degradation products, D-dimer, and tests for monitoring anticoagulants like heparin. It provides details on what each test measures, its normal range and clinical uses, and potential causes of abnormal results. It also discusses limitations and factors that can influence certain tests, as well as newer techniques for individualized monitoring and dosing of heparin.
This document discusses coronary artery anomalies associated with congenital heart disease. It notes that coronary anomalies can be associated with or due to congenital heart diseases like tetralogy of Fallot, transposition of the great arteries, truncus arteriosus, and pulmonary atresia with intact ventricular septum. It provides details on common coronary artery patterns and surgical management options for addressing anomalous coronary arteries during repair of various congenital heart defects.
1. The document describes a case of a 28-year-old female with cyanotic congenital heart disease who underwent an arterial switch operation with integrated ECMO support.
2. ECMO is a form of extracorporeal life support used for both cardiac and respiratory failure in adults. It involves pumping blood out of the body to an artificial lung for gas exchange before returning it to circulation.
3. The key components of an ECMO circuit include a blood pump, membrane oxygenator, tubing, heat exchanger, and monitoring equipment. Proper anticoagulation and flow rates are important for safety and effectiveness.
Evolution of management stratergy for TGAIndia CTVS
This document discusses the evolution of surgical management strategies for transposition of the great arteries (TGA). Early palliative procedures like atrial septectomy had high mortality. The atrial switch procedures (Senning and Mustard) developed in the 1950s-60s provided longer term survival but were associated with complications like arrhythmias, systemic ventricular dysfunction, and obstruction of venous pathways. The arterial switch operation developed in 1975 revolutionized treatment by anatomically correcting the defect. However, early attempts were unsuccessful due to technical challenges like coronary artery transfer. The landmark successful case by Jatene in 1975 established the arterial switch as the standard of care for TGA, though early mortality rates were still high at some centers. Long term
This document discusses heart transplantation, including indications, donor and recipient criteria. It provides a brief history of heart transplantation from early experiments to modern procedures. Key points include common indications for transplant like dilated cardiomyopathy, the importance of matching donor and recipient size and blood type, and selecting recipients without other medical issues that could impact outcomes. Contraindications and special considerations for procedures like ABO incompatible and pediatric transplants are also summarized.
Hypoplastic left heart syndrome (HLHS) is characterized by underdevelopment of the left side of the heart. It requires multi-stage surgical intervention to establish an adequate circulation. The first stage, known as the Norwood procedure, involves reconstructing the aortic arch and creating a shunt to provide pulmonary blood flow. Subsequent stages include the hemi-Fontan/Glenn procedure and final Fontan completion. Alternative treatments include heart transplantation or hybrid approaches. Long-term survival has improved but remains dependent on surgical expertise and individual patient risk factors. Ongoing management focuses on achieving balanced systemic and pulmonary circulations through each stage of treatment.
Pumps, oxygenators, and priming solutions are essential components of cardiopulmonary bypass. There are two main types of pumps - roller pumps and centrifugal pumps. Roller pumps work by rolling blood through tubing while centrifugal pumps use centrifugal force to move blood. Membrane oxygenators allow for gas exchange through a semi-permeable barrier, separating blood from gas, and eliminating the damage caused by bubble oxygenators. Proper selection of the components depends on factors such as flow needs, biocompatibility and minimizing trauma to blood during bypass.
This document discusses red blood cell and component therapy. It covers three pillars of patient blood management: preoperative detection of anemia, intraoperative hemostasis and cell salvage, and postoperative optimization. It then describes the components that make up component therapy, including packed red blood cells (PRBC), platelets, fresh frozen plasma, cryoprecipitate, and leukoreduced and irradiated PRBCs. Indications for transfusion and potential complications are also summarized.
1. The document outlines the history and evolution of surgical techniques for treating transposition of the great arteries (TGA).
2. Early techniques included atrial septal defect creation (Blalock-Hanlon) and atrial switch operations by Senning and Mustard using flaps or baffles.
3. The arterial switch operation was first successfully performed by Jatene in 1975 and modified by Lecompte, allowing coronary artery transfer.
4. Advances now allow arterial switch in neonates and extended to 6 months with support like ECMO.
This document discusses pediatric extracorporeal membrane oxygenation (ECMO) management including:
- Types of ECMO including venovenous and venoarterial
- Ventilator, coagulation, nutrition, inotrope, and sedation management of children on ECMO
- Monitoring of vital signs and investigations including echocardiograms and blood work
- Guidelines for weaning children from ECMO when stable and meeting criteria
- Potential complications of ECMO like bleeding, infection, and neurological injury and their management
- Procedures that can be done while a child is on ECMO
This document discusses the diagnosis and management of total anomalous pulmonary venous connection (TAPVC). It covers the types of TAPVC, diagnostic tools including ECG, CXR, echocardiography and catheterization, and surgical and interventional treatment options. The key points are:
1. TAPVC is diagnosed using imaging modalities like echocardiography, CT, and catheterization to identify the anomalous pulmonary vein drainage.
2. Surgical repair is the definitive treatment and involves anastomosis of the pulmonary veins to the left atrium. Factors like age, type of TAPVC, and presence of obstruction determine timing of surgery.
3. Post-operative management focuses on stabil
This document discusses the pathophysiology of constrictive pericarditis (CCP). CCP is caused by a thickened and fibrotic pericardium that restricts heart filling. This leads to 4 key hemodynamic changes: 1) impaired diastolic filling, 2) dissociation of intrathoracic and intracardiac pressures with respiration, 3) excessive ventricular coupling, and 4) heart rate dependent filling. The thick pericardium equalizes pressures in all chambers and abruptly halts early diastolic filling. Inspiration decreases left ventricular filling while increasing right ventricular filling via septal shift. Expiration causes the opposite effect.
This document discusses the history and evolution of mechanical heart valve substitutes from the 1950s to the present. It describes early ball and cage valves developed by Harken and Starr-Edwards in the 1950s-60s that helped ignite the field of prosthetic heart valves but had limitations. It then covers the development of tilting disc valves including the Bjork-Shiley valve that was later recalled due to failures, and bileaflet valves such as the St. Jude Medical valve made of durable pyrolytic carbon. The document traces the materials, designs and improvements made to mechanical heart valves over decades to increase effectiveness and safety.
This document provides a history of heart valve substitutes, beginning with the first implantation of homografts in the 1950s-1960s and moving to the development of xenograft valves fixed with glutaraldehyde in the 1960s-1970s. It discusses the work of Carpentier in developing low-pressure fixation and mechanical protection of valves. Various generations of bioprosthetic valves are summarized, including advances in fixation methods and anti-mineralization treatments. Stentless valves are introduced, providing improved hemodynamics over stented valves but requiring more complex implantation.
1. Ventricular septal defects (VSDs) are one of the most common congenital heart defects, accounting for 20-30% of cases in India.
2. The natural history and progression of a VSD depends on factors like its size, location, and the development of pulmonary hypertension.
3. Small VSDs have over a 50% chance of spontaneous closure by age 5, while larger defects often require surgical intervention. Without treatment, complications can include congestive heart failure, pulmonary vascular disease, bacterial endocarditis, and aortic regurgitation.
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2. TOPICS TO BE COVERED
• HISTORY
• PHYSIOLOGICAL ASPECTS OF IABP
• INDICATIONS & CONTRINDICATIONS
• INSTRUMENTATION & INSERTION
• IABP MONITORING
• NORMAL IAB PRESSURE WAVEFORM
• ABNORMAL IAB PRESSURE WAVEFORM
• WEANING & WITHDRAWL TECHNIQUE
• COMPLICATIONS
3. History
• Kantrovitz- Idea conceived/Hemidiaphragm wrapping
• Clauss- Systolic blood drainage and diastolic transfusion
• Moulopoulos (1961)-latex tubing with carbon dioxide
• Dennis (1963)- External counterpulsation
• Buckley et al/Mundth et al/Jacobey et al (1970s)
8. Physiological effects of IABP(CONTD.)
Magnitude of these effects depends upon -:
• Balloon volume - amount of blood displaced is proportional to
volume of balloon
• Heart rate - LV & aortic diastole filling time inversely related to HR,
shorter diastolic time produces lesser balloon augmentation per time
• Aortic compliance - inversely related to diastolic augmentation
9. IMPORTANT TERMS IN IABP PHYSIOLOGY
• Diastolic Pressure Time Index (DPTI) – Area between LV pressure and
aortic pressure waveform in diastole – Represents pressure and time
available for coronary blood flow
• Tension Time Index (TTI) – Area under the LV pressure waveform in
systole – Represents myocardial work and O2 demand
• Endocardial Viability Ratio ( EVR ) – Ratio of the DPTI to TTI –
Thought to represent the ratio of myocardial O2 supply to demand –
Myocardial ischaemia likely when ratio <0.7
12. Renal function
• Renal blood flow can increase up to 25%, secondary to increase in
cardiac output.
• Decrease in urine output after insertion of IABP should raise the
suspicion of juxta-renal balloon positioning.
13. Haematological effects
• The haemoglobin levels and the haematocrit often decrease by up to
5% because of haemolysis from mechanical damage to the red blood
cells.
• Thrombocytopenia can result from mechanical damage to the
platelets, heparin administration, or both.
14. INDICATIONS
• PRE OP
Acute MI
Complications of acute MI – VSR & MR
Cardiogenic shock
Refractory ventricular arrythmias
Refractory unstable angina
Refractory ventricular failure
High risk coronary intervention- LMCA, Sev LV Dysfn
15. INDICATIONS (contd.)
Intra op
Failed PCI /Catheterisation
High risk OPCABG
Difficult weaning from CPB in Sev LV Dysfn
Post op
Post surgery LV systolic failure unresponsive to inotropes
29. OTHER SITES OF IABP INSERTION
• ASCENDING AORTA
• SUBCLAVIAN ARTERY
• BRACHIAL ARTERY
• AXILLARY ARTERY
30. POSITIONING OF IABP
• The end of the ballon tip should
be ,∼2 to 3 cm distal to the
origin of the left subclavian
artery (at the level of the
carina),2nd ICS.
• Intraoperatively, balloon
placement can be ascertained
using TEE
31. MONITORING OF IABP
• CXR – VERIFY POSITION
• Daily Hb & platelet counts – to monitor hemolysis & thrombocytopenia
• Urine output
• Anticoagulation
CARE OF PATIENT WITH IABP
• Should be kept supine in bed (<40 degree elevation)
• Should be evaluated for limb ischemia
• Prophylactic antibiotic are not indicated
• Blood samples should not be obtained from central lumen of IABP
44. BALLON PUMP TRIGGERING
ECG PATTERN: Trigger- peak R wave, preset (default) trigger
mode
ARTERIAL PRESSURE: Systolic upstroke - trigger signal.
INTERNAL ASYNCHRONOUS MODE : The balloon inflates and
deflates at a preset rate regardless of the patient’s cardiac
activity. This mode is used in situations where there is no
cardiac output or ECG is unavailable.
45. A-FIB: Trigger mode of choice in AF
V PACE: Ventricular signal - trigger signal. Mode of
choice in 100% ventricular or AV paced rhythms.
60. TROUBLESHOOTING
• Loss of trigger:
Check
- ECG trace
- Replace ECG electrodes
- ECG cable
- Choose an alternate ECG lead
• Loss of pressure trace:
Check
- Pressure bag inflated to 300 mm Hg
- Patency of arterial line by withdrawing blood then flushing
- Transducer Level
61. • Alarms: Leak in IAB circuit / Rapid Gas Loss / IAB disconnected
- Ensure catheter tubing is not leaking
- Check connections along catheter
- Check catheter is not kinked
• Blood detected
- Blood detected in IAB catheter
- Check for blood in tubing if seen stop the pump
- Blood in the inflation catheter could imply rupture of the
balloon.
62. Complications associated with IABP
• Transient loss of peripheral pulse
• Limb ischaemia
• Thromboembolism
• Compartment syndrome
• Aortic dissection
• Local vascular injury—false
aneurysm, haematoma, bleeding
from the wound
• Infection
• Balloon rupture
• Balloon entrapment
• Haematological changes,
• Malpositioning causing cerebral
or renal compromise
64. WEANING OF IABP
• Timing of weaning - Patient should be stable for 12-24 hours
• Minimal inotropic support
• Decrease pump ratio from 1:1 to 1:2 or 1:3
• Decrease augmentation
• Monitor patient closely
• If patient becomes unstable, weaning should be immediately
discontinued
65. WITHDRAWL OF IABP
Ballon is put on “STAND BY” mode & disconnect
Ballon is deflated, withdraw until resistance met
66. • Allow backbleed
• Manual pressure proximal to
puncture site
• Manual pressure is then
applied for 30-45 min over
puncture site until adequate
haemostasis achieved
• Compressive dressing
IABP inflates at onset of diastole , cause diastolic augmentation which increases coronary perfusion and increase myocardial oxygen supply
Predominantly associated with enhancement of LV performance and also improves RV function .
As aortic compliance increase or SVR decrease the magnitude of diastolic augmentation decreases.
• Balloon inflation increases pressure difference between aorta and LV which augments the DPTI - This increases O2 supply
Balloon deflation reduces the afterload of the LV which reduces the TTI -- This reduces O2 demand
IABP decrease myocardial work and SVR , coronary perfusion increased
Severe MR secondary to PAPILLARY MIUSCLE DYSFUNCTION OR rupture after MI can lead to significant instability , initially managed by IABP
Life threatening complication of acute MI characterised by low cardiac output ,hypotension unresponsive to fluid administration , elevated filling pressure and tissue hypoperfusion leading to oliguria ,hyperlactemia and altered mental status . Class I indication for management of cardiogenic shock not rapidly reversed by pharmacological therapy.
IABP effective in stabilizing patients with refractory ventricular ectopy after MI by increasing coronary perfusion, reducing iuschemia and trans myocardial wall stress and maintain adequate systemic perfusion.
IABP is used for stabilization of patients with acute myocardial infarction referred for urgent cardiac surgery. IABP support is often initiated in the cardiac catheterization laboratory and continued through the perioperative period.
Elective placement is considered in high-risk patients such as those with significant left main stem disease, severe LV dysfunction (ejection fraction ,30%), congestive heart failure, cardiomyopathy, chronic renal failure, or cerebrovascular disease.
Weaning from cardiopulmonary bypass may be difficult in cases where aortic cross-clamping is prolonged, revascularization is only partially achieved, or preexisting myocardial dysfunction is present. Separation from cardiopulmonary bypass may be marked by hypotension and a low cardiac index despite the administration of inotropic drugs.
The use of IABP in this setting decreases LV resistance, increases cardiac output, and increases coronary and systemic perfusion, facilitating the patient’s weaning from cardiopulmonary bypass.
Essentially, if your aortic valve is incompetent, the diastolic balloon inflation will (instead of nourishing the coronary circulation) send a jet of blood though the aortic valve back into the left ventricle, increasing the preload. The valve was already doing this in diastole (hence the diastolic murmur)- but now the counterpulsation actually augments the regurgitation.
The presence of an aortic dissection would make one think twice about inserting a balloon pump. Even if the balloon somehow fails to actually touch the flap, its pulsations will send more blood into the false lumen, expanding the dissection. Any clots forming inside it will be battered around and potentially expelled into the systemic circulation.
10-25 cm long polyurethane bladder
30 to 60 cc capacity
Optimal 85 % of aorta occlusion (not 100 % )
The shaft of ballon catheter contains 2 lumens-
- one allows gas exchange from console to ballon
- second lumen for catheter delivery over guide wire & monitoring of central aortic pressure after installation .
Blood should not be drawn from central lumen for samples.
Mobile console
System for helium delivery
(Helium is often used because its low density facilitates rapid transfer of gas from console to the balloon. It is also easily absorbed into the blood stream in case of rupture of the balloon )
Computer for inflation & deflation control
Patient care should be carried out with 3 primary goals-
Evaluation in terms of hemodynamic status , systemic perfusion & relief of cardiac symptoms
Observation of early signs of complications including ischaemia , balloon mal-positioning , thrombus formation, bleeding and infection
Ensuring proper functioning of IABP , including correct timing, consistent triggering and trouble shout of alarms.
The balloon itself has a pressure transducer, and it generates a waveform.
Balloon pressure waveforms are also a source of information regarding the behavior of the IABP and its interaction with the cardiovascular physiology of patient.
About 40 milliseconds before the dicrotic notch, the IABP balloon inflates. This is timed with the ECG, usually - the end of the T wave is used as a marker that systole has finished. Why the delay? because even the best IABP pistons require a few milliseconds to shoot some helium into the balloon. Balloon deflation (which is also very rapid) is timed with the R wave.
The baseline pressure in the helium circuit should be around 10-15mmHg.
Balloon inflation causes augmentation of diastolic pressure and a second peak is observed. This peak is referred to as diastolic augmentation.
CARDIOVASCULAR CONSEQUENCES OF IABP –
Cardiovascular changes in diastolic events –
left ventricular diastolic volume is decreased due to systolic unloading.
improving left ventricular compliance
2. Cardiovascular changes in systolic pressure –
decrease in systolic pressure – decline in SBP by 10 %
decrease in end diastolic pressure upto 30 % - indicates systolic unloading
decrease in isometric phase of left ventricular contraction
decrease in left ventricular wall tensiomn & rate of left ventricular pressure rise
increase in cardiac output between 0.5 l & 1.0 litre /min.
Factors affecting diastolic augmentation -
Patient related factors –
Heart rate
MAP
STROKE VOLUME
SVR
IAB catheter related –
IAB position
IAB size
Kink in IAB catheter
IAB leak
Loew helium concenteration
IAB PUMP related –
Timing
The balloon plateau is a function of the pressure inside the helium balloon and the pressure inside the aorta, which relates to the elastic recoil of the aortic walls (and to some extent to the systemic vascular resistance as a whole).
Balloon plateau pressure might be low in the following circumstances:
- balloon is too small for the patient.
- patient is hypotensive, and has low peripheral vascular resistance (eg. septic shock or any other sort of vasoplegia)
- patient has a greatly reduced stroke volume (i.e. there is not enough ejected blood in the aorta to displace)
balloon is positioned too high or too low in the aorta
The consequence of this is a decreased diastolic augmentation, as well as a high aortic end-diastolic pressure. The balloon's low pressure cannot move much blood around the aorta, and the IABP is not being used to its full potential.
High balloon plateau pressure, with a square or rounded waveform, reflects either some sort of increase in pressure on the balloon itself, or some impedance to gas flow.
Balloon plateau pressure might be high in the following circumstances:
balloon catheter is kinked
balloon is too big for the patient
patient is incredibly hypertensive
balloon is positioned too high in the aorta
The consequences of this could be severe - the balloon could actually rupture from too much pressure. Or, you could be injuring the aorta. If the catheter is kinked, the balloon cannot empty, and balloon deflation could be delayed, which results in either a failure to improve afterload, or an actual increase in afterload.
The baseline pressure in the helium circuit should be around 10-15mmHg. If this pressure rises, there is likely some mechanical fault with the circuit, which limits the normal emptying of the balloon.
Balloon filling pressure baseline might be high in the following circumstances:
The balloon catheter is kinked and and balloon is not emptying properly
The system is overpressurised because the IABP is malfunctioning
The consequences of this are balloon could rupture (eventually). Additionally, the increased baseline pressure is transmitted to the aorta, which results in increased afterload and increased myocardial oxygen demand.
Most IABP consoles will begin to alarm with an irritating siren if the baseline pressure climbs over 20mmHg.
This could also be a major problem. The filling pressure is adjusted automatically; if this is not happening, there must be either a helium leak somewhere, or a failure of the automated filling mechanism. Alternatively, you have just run out of helium, and the tank needs to be replaced.
if the baseline filling pressure dives suddenly, the cause could be either a disconnection of the helium pipe, or (more disturbingly) a balloon rupture.
Timing is the process of determining the periods during the cardiac cycle when the balloon should inflate, how long it should remain inflated, and when it should deflate. The beneficial hemodynamic effects of IABPs are critically dependent on timing
Inflation of the balloon is triggered by the the beginning of diastole, which correlates with the middle of the T-wave.
The balloon is timed to deflate at the very end of diastole. This correlates with the R-wave on the ECG, and this is the most commonly used trigger for balloon deflation.
TRIGGER – EVENT THAT PUMP USES TO IDENTIFY THE ONSET OF CARDIAC CYCLE , PUMP MUST HAVE CONSISTENT TRIGGER IN ORDER TO PROVIDE PATIENT ASSIST
Early Inflation
- Early balloon inflation results in increased afterload
-Increased LV oxygen demand, due to increased afterload
-Decreased LV oxygen supply, due to decreased diastolic perfusion
-Decreased cardiac output, due to decreased stroke volume
Physiological effects:
potential premature closure of the aortic valve;
potential increase in LVEDV and LVEDP or PCWP;
increased LV wall stress or afterload; aortic regurgitation;
increased MVO2 demand.
Waveform characteristics:
-inflation of IAB after the dicrotic notch
absence of sharp ‘V’
Suboptimal diastolic augmentation
Physiological effects: suboptimal coronary artery perfusion
Waveform characteristics: -
-deflation of IAB is seen as a sharp decrease after diastolic augmentation;
-suboptimal diastolic augmentation;
-assisted aortic end-diastolic pressure may be equal to or less than the unassisted aortic end-diastolic pressure;
- assisted systolic pressure may increase
Physiological effects:
-suboptimal coronary perfusion;
-potential for retrograde coronary and carotid blood flow;
-suboptimal afterload reduction;
-increased MVO2 demand.
Waveform characteristics:
-assisted aortic end-diastolic pressure may be equal to the unassisted aortic end-diastolic pressure
-rate of increase of assisted systole is prolonged
-diastolic augmentation may appear widened.
Physiological effects:
-afterload reduction is essentially absent
increased MVO2 consumption because of the left ventricle ejecting against a greater resistance and a prolonged isovolumetric contraction phase
IAB may impede LV ejection and increase the afterload