1. Intra-Aortic Balloon Pump Counterpulsation
Iskander Al-Githmi, MD, FRCSC
Assistant Professor of Surgery
King Abdulaziz University

2. Historical Perspective
1958- Harken: Described the diastolic augmentation and counterpulsation to treat LV failure
1962-Moulopoulus: From Cleveland clinic, developed an experimental (IAB) whose inflation and deflation were timed to cardiac cycle
1968-Kantrowitz: Introduce the (IAB) to the clinical practice in patient with post-infarction cardiogenic shock

3. Intra-Aortic Pump Catherter

4. Physiologic effect of IABP
Reduction of left ventricular afterload
Increase aortic root pressure and coronary perfusion
Decrease myocardial oxygen demand

5. Coronary Artery Flow Autoregulation
Flow=Pressure/ resistnce

6. Indications: Cardiogenic shock or pump failure Unstable angina
Failure to wean patient off CPB
Prophylaxis:
High grade left main coronary stenosis
Post infarction acute mitral regurgitation and septal defect

7. Contraindications: Severe aortic regurgitation Aortic dissection
Severe peripheral vascular disease
Non-salvageable patient- Irreversible brain injury

8. Arterial Waveform

9. IABP Arterial Waveform

10. IAB catheter insertion technique
Seldinger technique
Cut-down

11. Timing

12. Balloon pressure waveform
1.zero baseline
2.Fill pressure baseline
3.IAB inflation
4.Pressure artifact/positive overshoot
5.Plateau pressure (IAB inflated)
6.IAB deflation
7.Vaccum artifact/negative overshoot
8.Return to baseline (IAB deflated)

13. Timing Basics To patient arterial waveform (always)
To patient EKG signal

14. Timing problems
Early inflation

15. Timing Problems
Early deflation

16. Timing Problem
Late deflation

17. Triggering Trigger on the R wave- preferred method
Good quality EKG signal and lead i.e unidirectional QRS complex, R wave is taller than P and T waves also it has adequate amplitude

18. Triggering
Good Lead

19. Triggering
QRS complex cause wandering timing

20. Complications Limb ischemia (10-25%) Balloon rupture
Thrombosis within the balloon
Infection
Bleeding
False aneurysm
Femoral neuropathy
Lymphocele

21. Questions

22. Question1 Asses the timing in the following strip Correct Timing
Early inflation and late deflation
Early inflation and early deflation
Correct inflation and early deflation
Late inflation and early deflation

23. Question 2 What is wrong with the arterial pressure line
AP line is dampened
Transducer need to zerod
The IBP is too high and the tip of art.line is being occluded as it hit the arch
Nothing
There is air in the pressure tubing

24. Question 3 Asses the timing in the following strip
Early inflation and early deflation
Late inflation and late deflation
Correct inflation and late deflation
Late inflation and early deflation
Correct timing

25. The pump is the peak trigger mode ,what part of the EKG complex is being recognized as the trigger event?
The R wave
The pacer spike
The arterial pressure waveform
The T wave
No trigger is seen

26. Question 5 The indications for IABP therapy include:
Cardiogenic shock following acute myocarditis
Acute mitral regurgitation with pulmonary edema from papillary muscle rupture
Acute VSD following myocardial infarction
Acute aortic regurgitation from edocarditis