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Intra-Aortic Balloon Pump

1. The primary purpose of the IABP is to increase myocardial oxygen supply while decreasing myocardial oxygen demand. It achieves its effects through coronary counter pulsation.

2. Typically inserted in the femoral artery, but the subclavian, axillary, iliac, or brachial arteries may be utilized. The catheter sits in the descending aorta and is advanced until the distal tip is 2-3cm above the left subclavian artery. (like ET above carina). Get chest x-ray to verify prior to transport.

3. Triggered by ECG (deflates on peak of R wave) or arterial line if poor ECG quality (inflates at closure of aortic valve, dicrotic notch).

4. Indications for IABP – cardiogenic shock, mechanical complications post MI (mitral regurgitation, ventral-septal defect, papillary muscle dysfunction).

5. Absolute contraindications – aortic aneurysm, aortic insufficiency, severe aortic disease, aortic stents.

6. Relative contraindications – abdominal aortic aneurysm, severe peripheral vascular disease, tachyarrhythmias.

7. IABP inflates during diastole to increase myocardial oxygen supply and perfuse coronary arteries.

8. IABP deflates right before systole to decrease myocardial oxygen consumption and afterload.

9. IABP Timing Errors

a. Early inflation is BAD since still balloon inflation begins before systole is complete.

b. Late inflation causes suboptimal coronary artery perfusion.

c. Early deflation causes suboptimal coronary artery perfusion and afterload reduction.

d. Late deflation is VERY BAD since it increases afterload and myocardial oxygen consumption.

10. Use a 1:1 ratio initially, up to a heart rate of 120 bpm. Ratios of 1:2 or 1:3 can be use with extreme tachycardia or in weaning from IABP.

11. Do not elevate the head > 30 degrees and do not flex the knee.

12. Assess radial pulses and urine output frequently during transport.

13. Mechanical hemolysis to RBCs will cause a decrease in hemoglobin and hematocrit levels.

14. The presence of rust colored flakes in the helium line indicates balloon rupture. This is an emergency, clamp the line, stop pumping, and disconnect the patient from the pump.

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