IABP Therapy

Question 1

What does IABP do

Answer 1

A cylindrical balloon sits in the aorta and counter-pulsates. It actively deflates in systole increasing forward blood flow by reducing after load and actively inflates in diastole increasing blood flow to the coronary arteries.

Mounted on a catheter and sits in the descending/thoracic aorta. Inserted into the right or left femoral artery.

Main goals: Increase coronary artery perfusion and reduce afterload.

Question 2

Indications for IABP therapy

Answer 2

> Cardiac failure after a cardiac surgical procedure
Mitral regurgitation
Preoperative treatment of complications due to MI
failed PTCA (Cardiac Stent)

*it’s all about myocardial oxygen demand and supply

Question 3

Goals of IABP therapy

Answer 3

> Decreases the work of the heart
Decreases myocardial oxygen demand
Decreases afterload
Increase coronary perfusion
Improve cardiac output (Q)
Decrease or limit myocardial ischemia
Prevent cardiogenic shock or limit the event

Question 4

Contraindications of IABP therapy

Answer 4

> Severe aortic insufficiency
Aortic aneurysmtest tip
Aortic dissectiontest tip
Limb ischemia
Thromboembolism

Question 5

Augmentation pressure

Answer 5

This pressure should be looked at as the highest pressure in the heart similar to systolic pressure. What is normal systolic? That is the goal. Too much augmentation pressure will be counterproductive. This is often a result of too much chemical balloon.
This is how much helium actually goes into the balloon

Question 6

Mean

Answer 6

The Mean is a calculated pressure by the IABP and should be looked at in the same manner as a MAP. This is how you titrate the chemical balloon.

What is the goal of a normal MAP? 65-90 mmHg

Question 7

Diastolic dip

Answer 7

This is the true reflection of afterload reduction.

The goal should be to a minimum of 5-10 mmHg.

Question 8

Unassisted versus assisted diastolic pressure

Answer 8

You want to see a decrease in assisted diastolic pressure from the previous unassisted diastolic pressure (diastolic dip)

Question 9

Unassisted versus assisted systolic pressure

Answer 9

You want to see a decrease in the assisted systolic pressure from the previous unassisted systolic pressure

Question 10

Pressures that you need to monitor with IABP therapy

Answer 10

Augmentation pressure
Mean pressure
Diastolic dip
Unassisted/assisted diastolic pressure
Unassisted/assisted systolic pressure

Question 11

Why is Helium used in IABP therapy?

Answer 11

> Used for IABP balloon, inflation
Helium will diffuse into the bloodstream and not cause issues
Helium is a small molecule, decreased risk for emboli, and it moves very quickly

Question 12

IABP transport considerations

Answer 12

1-IABP balloon size
2-patient presentation history
3-circulation assessment/ check all extremities
4-what is the urine output per hour?
5-is the patient balloon dependent? I put the IABP consul in standby. Can the patient handle it?

Question 13

Effects of IABP balloon inflation

Answer 13

1-increased coronary perfusion pressure
2-increased systemic perfusion pressure
3-increased O2 supply to both coronary and peripheral tissue
4-increased baroreceptor response
5-decreased sympathetic stimulation, causing decreased heart rate, decreased SVR and increased left ventricular function

Question 14

The effects of balloon deflation in IABP therapy

Answer 14

1-after load reduction, and therefore a reduction in myocardial oxygen consumption
2-reduction in peak systolic pressure, therefore reduction in LV work
3-increased cardiac output(Q)
4-improved ejection fraction
5- ejection fraction is normally 50 to 70%

Question 15

Triggering in IABP balloon pump therapy

Answer 15

A trigger is necessary to signal balloon pump to begin.

Trigger signal tells the computer another cardiac cycle has begun

Triggers include ECG, arterial, waveform, internal pressure or pacer.
ECG is most common and most reliable trigger. Should be a 5-lead and should be taped down for extra security

2ndary trigger is the arterial pressure and will automatically be used if the ECG fails.

Question 16

IABP therapy frequency

Answer 16

1:1 full therapy
1:2 tachycardia and weaning**
1:3 weaning

Question 17

Early inflation

Answer 17

> inflation of the IAB prior to aortic valve closure
waveform characteristics- inflation of IAB prior to diet chronic notch. It will look like a V in the second cardiac cycle.
physiological effects:
potential premature closer of the aortic valve
Potential increase in LVEDV and LVEDP
Increased LV wall stress, or afterload
Aortic regurgitation
Increased MVO2 demand

Question 18

Late inflation

Answer 18

> Inflation of the IAB marketed Lee after closure of the aortic valve

> waveform characteristics: inflation of IAB after dicrotic notch. Absence of the V.

> Physiological effects: sub, optimal, coronary artery perfusion.

Question 19

Early deflation

Answer 19

> Waveform characteristics: sharp ski slope type appearance. Aortic end diastolic pressure returns to unassisted level and assisted receives almost no assistance at all
Physiological effects: sub optimal decrease in LV oxygen demand, and poor afterload reduction

Question 20

Late deflation

Answer 20

> Waveform characteristics: 1- Assisted and unassisted aortic end diastolic pressure may be equal. 2- Diastolic augmentation may appear widened. 3- Plateau/crisp V.
Physiological effects: 1- afterload reduction is essentially absent. 2- increased MVO2 consumption due to LV ejecting against a greater resistance. 3- IAB may impede LV ejection and increase afterload.

test tip
Worst timing error!!

Question 21

IABP timing modes

Answer 21

Automatic- tracks, cardiac cycle, cardiac rhythm and adjust automatically

Semi automatic- the operator must adjust inflation and deflation

Question 22

Troubleshooting

Answer 22

> ECG trigger may not be functioning properly: 1- check patient leads. 2- change ECG lead source. 3- switch to A-line source.
Auto fill may fail: 1- check, helium and refill then check balloon. 2- rust flakes in pressure line.
Pump failure: if balloon is immobile >30 min, auto fill every five minutes** at least 10mL less than what the balloon can take.
If you don’t do this the patient will have blood clots form around the balloon and cause emboli to go everywhere.

Question 23

Auto purge

Answer 23

> Auto purge and Phil balloon when atmospheric pressure increases or decreases by 25-50mmHg
Pressure changes occur every 1k foot rise in elevation or 2k foot drop in elevation
* try to start your transport with at least 36 total purges
* purging can deplete your helium

Question 24

Reasons for sub optimal diastolic augmentation

Answer 24

> balloon in sheath
Balloon not unfolding
poor positioning
catheter kink
helium leak
low helium
timing
tachycardia
Augmentation control

Question 25

IABP complications

Answer 25

> limb ischemia/ thrombosis, or emboli
bleeding at insertion site
Groin hematomas
Aortic perforation and/or dissection
renal failure and bowel ischemia
Neuro complications including paraplegia
thrombocytopenia
cardiac arrest— switch from ECG to pressure trigger.

Question 26

General IABP Care

Answer 26

> assessed distal pulses Q 15 min
assess urine output
Assess insertion site q 15 min
document augmentation
document assisted/unassisted IBP. Ex: mean, diastolic augmentation and diastolic dip
maintain head of bed(HOB) less than 30°
log roll, re-zero balloon pump, and fast flush every hour.