Intra Aortic Balloon Pump (IABP)

🚨 IABP:

🗣️Let’s discuss Intra Aortic BalloonPump (IABP)🩺🫀:-

🔴🌟 What is IABP?

The IABP is a mechanical circulatory support device that improves coronary perfusion and decreases myocardial workload using counterpulsation.

🧠 Mechanism of Action

⏩ Inflates in diastole → ↑ coronary and end-organ perfusion.

Timing: At the dicrotic notch.

⏩ Deflates in systole → ↓ LV afterload.

Primary Effects:

• ↓ LV Afterload and myocardial oxygen demand.

• ↑ Cardiac output (10-20%).

• ↓ Pulmonary capillary wedge pressure (PCWP).

• ↑ Coronary perfusion

🔴 🔑 When to Use IABP?

🚑 Clinical Indications:

 1️⃣ Acute Mitral Regurgitation (MR): Reduces afterload and regurgitant volume - critical as a bridge to surgery.

2️⃣ Ventricular Septal Rupture (VSR) post-MI: Stabilizes hemodynamics before surgical repair.

3️⃣ Non-AMI Cardiogenic Shock (CS): Especially with high systemic vascular resistance (SVR) (e.g., cold, clammy shock).

4️⃣ Refractory Angina: Palliation of symptoms when medical therapy fails - as a bridge to revascularization (eg LM PCI)

5️⃣ High-Risk (Protected) PCI: Hemodynamic stabilization during complex procedures.

🔴 🔍 How to choose between inotropes/vasopressors and IABP?

💡 SVR considerations in Cardiogenic Shock (CS):

• High SVR ("cold and clammy" CS): IABP is most effective. ↓ Afterload, improves perfusion by reducing ventricular wall stress.

• Low SVR ("warm and wet" CS): IABP is less effective. These patients benefit more from inotropes or vasopressors to restore vascular tone. (Think patients with mixed shock)

✅ Rule of Thumb:

• High SVR → IABP is preferred.

• Low SVR → Inotropes/vasopressors are first-line.

🪢 Combined Approach: Often used together in severe cardiogenic shock: IABP ↓ afterload. Inotropes ↑ contractility.

8🔴 🚩 Contraindications

❌ Absolute:

• Severe Aortic Insufficiency (AI): Worsens regurgitation (Inflation in diastole pushes blood back into the LV).

• Aortic Dissection: Risk of catastrophic rupture.

⚠️ Relative:

• Severe Peripheral Vascular Disease (PVD): Challenges insertion and pre-disposes to limb ischemia.

• Tachycardia (>120-150 bpm): Eg AFib RVR - Results in inadequate augmentation (not enough time for IABP to expand and collapse)

• Sepsis: High risk of complications with limited benefit.

🔴 🛠️ Troubleshooting common issues

⚠️Watch our for:

• Limb ischemia - monitor distal pulses

• Renal dysfunction - Improper positioning - ⬇️ blood flow to the kidneys

• ↓ Augmentation - consider low SVR state (sepsis)

🔔 Waveform abnormalities:

• Flat waveform → Check balloon position (CXR).

• Reduced augmentation → Check helium supply or balloon integrity.

🔧 Alarms:

• Balloon rupture 🆘 → Blood in helium tubing = STOP IABP immediately.

• Trigger failure: Recalibrate ECG or arterial signal.

🔴 📚 🔑 Key Trials on IABP

1️⃣ IABP-SHOCK II (2012):

• Population: Cardiogenic shock post-MI.

• Result: No mortality benefit at 30 days with IABP.

• Takeaway: Use selectively in non-AMI CS with high SVR or mechanical complications.

2️⃣ CRISP-AMI (2011):

• Population: STEMI w/o shock.

• Result: No infarct size reduction with IABP.

• Reinforces use in high-risk scenarios only.

3️⃣ Meta-analysis (Post-IABP-SHOCK II):

Benefits in acute MR, VSR, and high SVR shock as a bridge to definitive treatment.

🔴 7. Practical tips for IABP management in cardiac ICU

✅ Confirm position daily (CXR).🩻

✅ Reassess timing after BP/HR changes.

✅ Monitor for complications (bleeding, infection, ischemia).

✅ Switch to advanced MCS (e.g., Impella, ECMO) if IABP fails.🩻👇

🔴 🎯 8. Takeaways

The IABP is a valuable adjunct in specific scenarios:

 1️⃣ High SVR cardiogenic shock.

 2️⃣ Acute mechanical complications like MR or VSR.

 3️⃣ High-risk PCI.

💡 Pro tip: Anticoagulation may not be required with IABP 1:1 augmentation! (Check your institutional policy)