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Medicine

The Intra-Aortic Balloon Pump

Published: February 5th, 2021

DOI:

10.3791/62132

1Division of Cardiovascular Medicine, University of Nebraska Medical Center, 2Minneapolis Heart Institute, 3Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna, 4Department of Experimental and Clinical Pharmacology, Medical University of Warsaw, Center for Preclinical Research and Technology CEPT, 5Department of Internal Medicine II, Division of Cardiology, Medical University of Vienna

We describe the steps for the percutaneous implantation of the intra-aortic balloon pump (IABP), a mechanical circulatory support device. It acts by counterpulsation, inflating at the onset of diastole, augmenting diastolic aortic pressure and improving coronary blood flow and systemic perfusion, and deflating before systole, reducing left ventricular afterload.

Cardiogenic shock remains one of the most challenging clinical syndromes in modern medicine. Mechanical support is being increasingly used in the management of cardiogenic shock. Intra-aortic balloon pump (IABP) is one of the earliest and most widely used types of mechanical circulatory support. The device acts by external counterpulsation and uses systolic unloading and diastolic augmentation of aortic pressure to improve hemodynamics. Although IABP provides less hemodynamic support when compared with newer mechanical circulatory support devices, it can still be the mechanical support device of choice in appropriate situations because of its relative simplicity of insertion and removal, need for smaller size vascular access and better safety profile. In this review, we discuss the equipment, procedural and technical aspects, hemodynamic effects, indications, evidence, current status and recent advances in the use of IABP in cardiogenic shock.

Cardiogenic shock is a clinical condition characterized by decreased end organ perfusion due to severe cardiac dysfunction. The most widely accepted definition of cardiogenic shock is based on the Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock trial (SHOCK)1 and Intra-aortic Balloon Support for Myocardial Infarction with Cardiogenic Shock (IABP-SHOCK-II) trial2 and includes the following parameters:

1. Systolic blood pressure <90 mm Hg for ≥30 min or vasopressor and/or mechanical support to maintain SBP ≥90 mm Hg

2. Evid....

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This protocol follows the guidelines of institutional human research ethics committee.

1. Pre-insertion preparation

NOTE: The IABP is preferably inserted in the cardiac catheterization lab under fluoroscopic guidance. Bedside placement can be considered in very critical clinical situations.

  1. Begin by preparing the catheterization laboratory for the procedure. Prepare sterile drapes and chlorhexidine or povidone iodine, IABP control unit, IABP catheter, ultr.......

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Despite being used for many decades now, the evidence on IABP use has been controversial. Routine use of IABP in patients with AMI and cardiogenic shock is not recommended. The previous guidelines of the American Heart Association/American College of Cardiology (AHA/ACC) and the European Society of Cardiology (ESC) strongly recommended the use of the IABP in patients with AMI-associated cardiogenic shock (Class I B and Class I C) on the basis of pathophysiological considerations, non-randomized trials and registry data. .......

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Mechanical circulatory support is a rapidly evolving field. Even with the arrival of newer support devices, IABP remains the most widely used and simplest to deploy mechanical circulatory support device available currently25. In this article we describe in detail, the procedure for percutaneous insertion of IABP, the indications, evidence, troubleshooting and complications. Despite conflicting evidence regarding the use of IABP in AMI-related cardiogenic shock, it remains the most widely used form.......

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None

....

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Name Company Catalog Number Comments
IABP catheter and console Getinge Sensation Plus
Micropuncture Introducer Set Cook Medical G48006
Sterile drapes Haylard
Ultrasound GE
Lidocaine Pfizer

  1. Hochman, J. S., et al. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should We Emergently Revascularize Occluded Coronaries for Cardiogenic Shock. New England Journal of Medicine. 341 (9), 625-634 (1999).
  2. Thiele, H., et al. Intraaortic Balloon Support for Myocardial Infarction with Cardiogenic Shock. New England Journal of Medicine. 367 (14), 1287-1296 (2012).
  3. Berg, D. D., et al. Epidemiology of Shock in Contemporary Cardiac Intensive Care Units. Circulation Cardiovascular Quality and Outcomes. 12 (3), 005618 (2019).
  4. Jeger, R. V., et al. Ten-year trends in the incidence and treatment of cardiogenic shock. Annals of Internal Medicine. 149 (9), 618-626 (2008).
  5. Harken, D. E. The surgical treatment of acquired valvular disease. Circulation. 18 (1), 1-6 (1958).
  6. Moulopoulos, S. D., Topaz, S. R., Kolff, W. J. Extracorporeal assistance to the circulation and intraaortic balloon pumping. Transactions of the American Society for Artificial Internal Organs. 8, 85-89 (1962).
  7. Kantrowitz, A., et al. Initial clinical experience with intraaortic balloon pumping in cardiogenic shock. JAMA. 203 (2), 113-118 (1968).
  8. Krishna, M., Zacharowski, K. Principles of intra-aortic balloon pump counterpulsation. Continuing Education in Anaesthesia Critical Care & Pain. 9 (1), 24-28 (2009).
  9. Mueller, H., et al. The effects of intra-aortic counterpulsation on cardiac performance and metabolism in shock associated with acute myocardial infarction. The Journal of clinical investigation. 50 (9), 1885-1900 (1971).
  10. Kern, M. J., et al. Enhanced coronary blood flow velocity during intraaortic balloon counterpulsation in critically ill patients. Journal of American College of Cardiology. 21 (2), 359-368 (1993).
  11. Patterson, T., Perera, D., Redwood, S. R. Intra-aortic balloon pump for high-risk percutaneous coronary intervention. Circulation: Cardiovascular Interventions. 7 (5), 712-720 (2014).
  12. Parissis, H., et al. IABP: history-evolution-pathophysiology-indications: what we need to know. Journal of Cardiothoracic Surgery. 11 (1), 122 (2016).
  13. O'Gara, P. T., et al. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 127 (4), 529-555 (2013).
  14. Ibanez, B., et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. 39 (2), 119-177 (2018).
  15. Santa-Cruz, R. A., Cohen, M. G., Ohman, E. M. Aortic counterpulsation: a review of the hemodynamic effects and indications for use. Catheterization and Cardiovascular Interventions. 67 (1), 68-77 (2006).
  16. Hendrickx, H. H., Berkowitz, D. Differences between intra-aortic balloon pumps and their use. Critical Care Medicine. 10 (11), 796-797 (1982).
  17. Parissis, H., Soo, A., Leotsinidis, M., Dougenis, D. A statistical model that predicts the length from the left subclavian artery to the celiac axis; towards accurate intra aortic balloon sizing. Journal of Cardiothoracic Surgery. 6, 95 (2011).
  18. Seldinger, S. I. Catheter Replacement of the Needle in Percutaneous Arteriography: A New Technique. Circulation. 39 (5), 368-376 (1953).
  19. Pucher, P. H., Cummings, I. G., Shipolini, A. R., McCormack, D. J. Is heparin needed for patients with an intra-aortic balloon pump. Interactive Cardiovascular and Thoracic Surgery. 15 (1), 136-139 (2012).
  20. Collet, J. P., et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European Heart Journal. , (2020).
  21. Thiele, H., et al. Intraaortic Balloon Pump in Cardiogenic Shock Complicating Acute Myocardial Infarction. Circulation. 139 (3), 395-403 (2019).
  22. Unverzagt, S., et al. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Systematic Review. (3), 007398 (2015).
  23. Deppe, A. C., et al. Preoperative intra-aortic balloon pump use in high-risk patients prior to coronary artery bypass graft surgery decreases the risk for morbidity and mortality-A meta-analysis of 9,212 patients. Journal of Cardiac Surgery. 32 (3), 177-185 (2017).
  24. Li, Y., et al. Effect of an intra-aortic balloon pump with venoarterial extracorporeal membrane oxygenation on mortality of patients with cardiogenic shock: a systematic review and meta-analysis. European Journal of Cardiothoracic Surgery. 55 (3), 395-404 (2019).
  25. Wernly, B., et al. Mechanical circulatory support with Impella versus intra-aortic balloon pump or medical treatment in cardiogenic shock-a critical appraisal of current data. Clinical Research Cardiology. 108 (11), 1249-1257 (2019).
  26. Seto, A. H., et al. Real-time ultrasound guidance facilitates femoral arterial access and reduces vascular complications: FAUST (Femoral Arterial Access With Ultrasound Trial). JACC Cardiovascular Interventions. 3 (7), 751-758 (2010).
  27. Erdogan, H. B., et al. In which patients should sheathless IABP be used? An analysis of vascular complications in 1211 cases. Journal of Cardiac Surgery. 21 (4), 342-346 (2006).
  28. Huckaby, L. V., Seese, L. M., Mathier, M. A., Hickey, G. W., Kilic, A. Intra-Aortic Balloon Pump Bridging to Heart Transplantation: Impact of the 2018 Allocation Change. Circulation : Heart Failure. 13 (8), 006971 (2020).
  29. Estep, J. D., et al. Percutaneous placement of an intra-aortic balloon pump in the left axillary/subclavian position provides safe, ambulatory long-term support as bridge to heart transplantation. JACC Heart Failure. 1 (5), 382-388 (2013).
  30. Jeevanandam, V., et al. The Hemodynamic Effects of Intravascular Ventricular Assist System (iVAS) in Advanced Heart Failure Patients Awaiting Heart Transplant. The Journal of Heart and Lung Transplantation. 36 (4), 194 (2017).
  31. Siriwardena, M., et al. Complications of intra-aortic balloon pump use: does the final position of the IABP tip matter. Anesthesia Intensive Care. 43 (1), 66-73 (2015).
  32. Maccioli, G. A., Lucas, W. J., Norfleet, E. A. The intra-aortic balloon pump: a review. Journal of Cardiothoracic Anesthesia. 2 (3), 365-373 (1988).
  33. The intra-aortic balloon pump: a review. Citoday Available from: https://citoday.com/device-guide/european/intra-aortic-balloon-pumps-1 (2020)

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