1. Intra-aortic Balloon Pump Counterpulsation
Aidah Abu Elsoud Alkaissi
RN, BSN, MSN, PhD
Intra-aortic Balloon Pump Counterpulsation
4/26/2017

2. Next, we saw the use of the balloon pump extended to support patients who could not be separated from the heart
lung machine despitepressorsupport. This was a group of patients who were essentialy dead, i.e. when the pump was turned off.l
4/26/2017

3. namely,ischemiadue to unstable angina
namely,ischemiadue to unstable angina. Patients with critical coronary anatomymay not respond to medical therapy
or may become acutely ischemic in theCath. Lab. during coronaryangiography.Using percutaneoustechnique, the cardiologist can then quickly insert a balloon pump and stabilize the patient, leading to a pain free patient
4/26/2017

4. 4/26/2017

5. Kent H. Rehfeldt, MD,* and Roger L. Click, MD†
Journal of Cardiothoracic and Vascular Anesthesia, Vol 17, No 6 (December), 2003: pp
Intraoperative Transesophageal Echocardiographic Imaging of an Intra-aortic Balloon Pump Placed via the Ascending Aorta
Kent H. Rehfeldt, MD,* and Roger L. Click, MD†
THE USE OF A perioperative intra-aortic balloon pump(IABP) in cardiac surgical patients is relatively common,
occurring in 2% to 12% of cases.1 Although a femoral arteryinsertion site is typically used, the failure rate for IABP insertion
via the femoral artery has been reported to be around 5%.2,3In patients in whom the IABP cannot be inserted from a
femoral approach, placement via the ascending aorta may bepossible. When this transthoracic approach is used, intraoperative
transesophageal echocardiography (TEE) is especiallyuseful in confirming correct position of the IABP in the thoracic
aorta, as described in the following cases.
4/26/2017

6. From the Section of Cardiology and Cardiovascular Surgery, Norfolk General Hospital and Eastern Virginia Medical School, Norfolk, Virginia
Prophylactic Use of Intra-aortic Balloon Pump in Aortocoronary Bypass for Patients with Left Main Coronary Artery Disease
H. R. RAJAI, M.D., et al
Aortocoronary bypass surgery in patients with left main coronary artery disease is reported to have an operative mortality of between 1.4 and 39%. It is generally accepted that the operative mortality in this group of patients is considerably greater than in routine bypass candidates, presumably due to the large amount of myocardium threatened
by a single lesion. In an effort to preserve threatened left ventricular myocardium, intra-aortic balloon pumping was instituted prophylactically prior to sternotomy in 20 consecutive patients with left main coronary artery disease (luminal narrowing greater than 50%). Sixty per cent of these patients had New York Heart Association Class IV angina, 25% had Class III, and 15% Class II. Fifty per cent of the patients in this group presented with unstable angina. Operative patients requiring left ventricular aneurysmectomy and/or valve replacement, were excluded. No operative deaths have been encountered in 20 consecutive patients managed in this manner. One patient displayed signs of myocardial infarction in the postoperative period.
Correctable peripheral vascular ischemic complications of pump insertion were encountered in three patients. Preliminary results from this ongoing study support the hypothesis that prophylactic intra-aortic balloon pumping is a low risk procedure that should be utilized routinely in aortocoronary bypass surgery for left main coronary artery disease
4/26/2017

7. Objectives
Demonstrate a basic understanding of the purpose and desired outcomes of IABP
Identify key patient safety issues associated with the use and monitoring of IABP
Describe nursing interventions related to IABP use and monitoring
4/26/2017

8. IABP PURPOSE Improves cardiac function during cardiogenic shock.
26-28 cm balloon surrounds end of centrally placed catheter (from groin)
Placed into descending thoracic aorta
Inflates in diastole - fills coronary arteries retrograde
Deflates in systole - decreases LV afterload
4/26/2017

9. Indications 1. Refractory ventricular failure 2. Cardiogenic shock
3. Unstable refractory angina
4. Impending (To threaten to happen) infarction
5. Mechanical complications due to acute myocardial infarction
6. Ischemia related intractable (Difficult to manage) ventricular arrhythmias
4/26/2017

10. Indications
7. Cardiac support for high-risk general surgical and coronary angiography/ angioplasty patients
8. Septic shock
9. Weaning from cardiopulmonary bypass
10. Support for failed angioplasty and valvuloplasty
4/26/2017

11. Contraindications Severe aortic insufficiency
2. Abdominal or aortic aneurysm
3. Severe calcific aorta-iliac disease or peripheral vascular disease
4. Scarring of the groin
4/26/2017

12. Contraindications
Contraindications: Incompetent aortic valve (because inflation increases aortic regurgitation)
􀂄 Nursing: Head of bed must be kept 30 degrees or lower. Must monitor for infection or bleeding
􀂄 IABP augments cardiac output by 15% & provides total support for the heart; which allows the heart to recover
4/26/2017

13. 4/26/2017

14. What is an IABP?
The Intra-Aortic Balloon Counterpulsation system is a volume displacement device.
A device used to reduce left ventricular systolic work, left ventricular end-diastolic pressure, and wall tension
Decreases oxygen consumption
Increases cardiac output, perfusion, pressure and volume to Coronary Artries
4/26/2017

15. 4/26/2017

16. The System 97e is a helium charged, mobile, Intra-Aortic Balloon Pump (IABP).
4/26/2017

17. Intra-Aortic Balloon Pump (IABP) -.
It is inserted into the descending aorta via the femoral artery either percutaneously or by surgical cut-down.
The balloon rapidly deflates just before ventricular systole to reduce the impedance (A measure of the total opposition to current flow in an alternating current circuit) to left ventricular ejection
4/26/2017

18. It consists of a catheter and a drive console.
The catheter has a long balloon mounted on the end.
It should be positioned so that the tip is approximately 1 to 2 cm below the origin of the left subclavian artery and above the renal arteries.
On chest x-ray the tip should be visible in the 2nd or 3rd intercostal space
4/26/2017

19. Surgical Indications Post Surgical Myocardial Dysfunction
Support for weaning from Cardiopulmonary Bypass (CPB)
Cardiac support following correction of anatomical defects
Maintenance of graft patency post CABG
Pulsatile flow during CPB
4/26/2017

20. Desired Outcome
Appropriately timed blood volume displacement (30 – 50 mL) in the aorta by the rapid shuttling of helium gas in and out of the balloon chamber, resulting in changes in inflation and deflation hemodynamics
4/26/2017

21. Insertion Techniques
A percutaneous placement of the IAB via the femoral artery using a modified Seldinger technique (a needle is used to puncture the structure and a guide wire is threaded through the needle; when the needle is withdrawn, a catheter is threaded over the wire; the wire is then withdrawn, leaving the catheter in place.)
After puncture of the femoral artery a J-shaped guide wire is inserted to the level of the aortic arch and then the needle is removed.
The arterial puncture side is enlarged with the successive placement of an 8 to 10,5Fr dilator/sheath combination. Only the dilator needs to be removed
4/26/2017

22. 4/26/2017

23. Insertion Techniques
Continuing, the balloon is threaded over the guide wire into the descending aorta just below the left subclavian artery.
The sheath is gently pulled back to connect with the leak- proof cuff on the balloon hub, ideally so that the entire sheath is out of the arterial lumen to minimize risk of ischemic complications to the distal extremity.
4/26/2017

24. Insertion Techniques
There are alternative routes for balloon insertion.
In patients with extremely severe peripheral vascular disease or in pediatric patients the ascending aorta or the aortic arch may be entered for balloon insertion.
Other routes of access include subclavian, axillary or iliac arteries.
4/26/2017

25. Intra-aortic balloon catheter
A balloon catheter comprising an outer tube, a balloon, a tip and an inner tube, a proximal portion of said inner tube disposed within the outer tube and a distal portion of said inner tube extending beyond a distal end of the outer tube, the tip, a distal end of the inner tube, and a distal end of the balloon membrane are connected,
4/26/2017

26. Arterial Pressure
Balloon Pump
Console
4/26/2017

27. IABP correct placement
4/26/2017

28. 4/26/2017

29. Inflation
It inflates immediately following aortic valve closure to to augment diastolic coronary perfusion pressure.
4/26/2017

30. the intra-aortic balloon positioned in the descending thoracic aorta, just below the left subclavian artery, but above the renal arteries.
4/26/2017

31. Aortic volume and pressure are increased through displacement
The principles of counterpulsation state that the balloon should be inflated at the start of diastole, just prior to the Dicrotic Notch.
Aortic volume and pressure are increased through displacement
4/26/2017

32. Increased coronary perfusion pressure
Increased systemic perfusion pressure
Increased O2 supply to both the coronary and peripheral tissue
Increased baroreceptor response
Decreased sympathetic stimulation causing decreased Heart Rate, decreased Systemic Vascular Resistance, and increased Left Ventricular function
Inflation of IABP Causes
4/26/2017

33. Deflation
The balloon rapidly deflates just before ventricular systole to reduce Left Ventricular work
Deflation creates a "potential space" in the aorta, reducing aortic volume and pressure
4/26/2017

34. Reduction in peak systolic pressure, therefore a reduction in LV work
Afterload reduction and therefore a reduction in myocardial oxygen consumption (MVO2)
Reduction in peak systolic pressure, therefore a reduction in LV work
3. Increased Cardiac Output
4. Improved ejection fraction (The amount of blood pumped out of a
ventricle during each heart beat. The ejection fraction evaluates how well the heart is pumping; Normally percent) and forward flow
Deflation of the IABP Causes
4/26/2017

35. Factors Affecting Diastolic Augmentation
1. Patient Hemodynamics
Heart Rate
Stroke Volume
Mean Arterial Pressure
Systemic Vascular Resistance
4/26/2017

36. Factors Affecting Diastolic Augmentation
2. Intra-aortic Balloon Catheter
IAB in sheath
IAB not unfolded
IAB position
Kink in IAB catheter
IAB leak
Low Helium concentration
4/26/2017

37. Factors Affecting Diastolic Augmentation
3. IABP
Timing
Position of the IAB augmentation control
4/26/2017

38. Review of Arterial Pressure Landmarks
AVO = Aortic valve opens, beginning of systole PSP = Peak systolic pressure, % of stroke volume has been delivered DN = Dicrotic notch, signifies aortic valve closure and the beginning of diastole AEDP = Aortic end diastolic pressure
4/26/2017

39. The rule of inflation is: inflate just prior to the Dicrotic Notch
To accomplish the goals of inflation, the balloon must be inflated at the onset of diastole
The result of properly timed inflation is a pressure rise PDP/DA = Peak diastolic pressure or diastolic augmentation, this is the pressure generated in the aorta as the result of inflation
4/26/2017

40. Review of Arterial Pressure Landmarks in 1:2 Assist
PAEDP = Patient aortic end diastolic pressure, this is the patient's unassisted diastole PSP = Peak systolic pressure, this is the patient's unassisted systole PDP/DA = Peak diastolic pressure or diastolic augmentation, this is the pressure generated in the aorta as the result of inflation BAEDP = Balloon aortic end diastolic pressure, this is the lowest pressure produced by deflation of the IAB APSP = Assisted peak systolic pressure, this systole follows balloon deflation and should reflect the decrease in LV work
4/26/2017

41. Inflation Hemodynamics
Coronary artery blood flow and pressure are increased
Increased renal and cerebral blood flow
Increased diastolic pressure increases perfusion to distal organs and tissues
4/26/2017

42. Triggering
It is necessary to establish a reliable trigger signal before balloon pumping can begin
The computer in the IAB console needs a stimulus to cycle the pneumatic system, which inflates and deflates the balloon
The trigger signal tells the computer that another cardiac cycle has begun
4/26/2017

43. Triggering
In most cases it is preferable to use the R wave of the ECG as the trigger signal
However, there are other trigger options for instances when the R wave cannot be used or is not appropriate
4/26/2017

44. Trigger Loss
The console MUST see a trigger to initiate an inflate/deflate cycle
If no trigger is seen when the clinician attempts to start pumping, no pumping will occur and an alarm will be sounded
If the trigger is lost after pumping starts, no further pumping will occur until a trigger is re-established
The pump will go to STANDBY and an alarm will be sounded
4/26/2017

45. Trigger Loss
If the current trigger is lost the clinician can choose an alternate, available trigger to resume pumping
For example, if the ECG lead becomes disconnected the Arterial Pressure trigger may be selected until the ECG is re- established
4/26/2017

46. ECG Trigger
Since triggering on the R wave of the ECG is preferred, it is very important to give the IABP a good quality ECG signal and lead
4/26/2017

47. Poor ECG Choices
Note: changing QRS morphology may cause wandering timing
Note: tall T waves may cause double triggering or may alter previously set timing points
Note: wandering baseline may cause skipped trigger
Note: artifact may cause inappropriate triggering 
4/26/2017

48. ECG Gain
In addition to selecting a lead with a QRS morphology that provides consistent, appropriate triggering, it is important to ensure the QRS complex has adequate amplitude
The computer has a minimum height requirement to recognize the initial deflection as an R wave, whether upright or negative in configuration
4/26/2017

49. Triggering on the Arterial Pressure Waveform
Arterial pressure provides another signal to the IABP to determine where the cardiac cycle begins and ends
It is used when the ECG has too much interference from patient movement or poor lead connection
There are limitations to triggering on the arterial pressure curve
Therefore AP trigger should be considered a backup trigger and not the one used as the primary trigger
The PDP/DA influences the gradient for coronary artery perfusion
Irregular heart rates and irregular pulse pressures can cause the pump to not see a trigger where it expects to find one
If this happens, pumping will be temporarily interrupted as the computer relearns the parameters
Late deflation will also cause missed triggers and an interruption in pumping
4/26/2017

50. Valid Trigger Indications
Accurate Heart Rate displayed on pump
Assist marker on/under ECG in same ratio as assist ratio, e.g. if in 1:1 there should be one assist marker per ECG complex
Flash heart symbol next to HR on screen
4/26/2017

51. ECG Trigger Loss Possible Cause Operator Action
Loose or disconnected ECG leads
Current type of ECG trigger is not appropriate
ECG signal too small
Very noisy ECG
Monitor input disconnected
Patient's cardiac activity ceased
Check electrodes, lead wires and connections.
Change to alternate appropriate ECG trigger.
Change lead selection; change trigger source; check electrode placement. Increase ECG gain if applicable.
Change to AP trigger.
Check connections from monitor and secure.
CHECK PATIENT FOR CARDIAC ACTIVITY
4/26/2017

52. Arterial line dampened, disconnected or turned OFF
Trigger Loss
Possible Cause
Operator Action
Arterial Pressure
Arterial line dampened, disconnected or turned OFF
Heart Rate is irregular
3. Patient's cardiac activity ceased
Check arterial tracing; flush line; check transducer and monitor input; change to ECG trigger.
Change to ECG trigger
CHECK PATIENT FOR CARDIAC ACTIVITY
4/26/2017

53. TIMING and WEANING
Balloon synchronization starts usually at a beat ratio of 1:2.
This ratio facilitates comparison between the patient’s own ventricular beats and augmented beats to determine ideal IABP timing.
Errors in timing of the IABP may result in different waveform characteristics and a various number of physiologic effects.
4/26/2017

54. TIMING and WEANING
If the patient’s cardiac performance improves, weaning from the IABP may begin by gradually decreasing the balloon augmentation ratio (from 1:1 to 1:2 to 1:4 to 1:8) under control of hemodynamic stability.
After appropriate observation at 1:8 counterpulsation the balloon pump is removed.
4/26/2017

55. Gas Alarms/Balloon Pressure Waveform
During a cycle of inflation/deflation, helium is rapidly moved in and out of the balloon. The environment within the balloon and the surrounding forces that affect balloon behavior all contribute to a predictable pattern of gas flow and pressure.
The Arrow International IABP consoles have in-line transducers that relay the pattern of gas pressure during the inflate/deflate cycle.
The gas pressure characteristics are converted into a waveform that is reflective of the behavior of the gas.
This transduced waveform can tell us much about the interaction of the balloon within the patient's aorta.
Thorough understanding of the balloon pressure waveform is also important for efficient troubleshooting of the console as most of the alarms are based on this gas surveillance system.
4/26/2017

56. Normal Waveform Variations
Tachycardia
Bradycardia
Hypertension
Hypotension
4/26/2017

57. and demand (DPTI:TTI ratio)
4/26/2017

58. Abnormal Waveform Variation: Wide Inflation and/or Deflation Artifact
Note the wide inflation and deflation artifacts.
This is generally indicative of something impeding the rapid inflation and deflation of the IAB, such as kinking of the gas lumen.
This may result in poor augmentation and/or poor afterload reduction.
It may also lead to helium/gas loss alarms in higher Heart Rates when in a 1:1 assist ratio. It may precede high pressure/kinked line alarms.
The goal is to eliminate the partial obstruction, if possible, to enable the IABP to assist the patient better by moving the helium more rapidly.
4/26/2017

59. Note the BPW baseline is below 0.
Abnormal Waveform Variation: Helium Loss / Gas Loss / Gas Leakage Alarms
Note the BPW baseline is below 0.
This indicates that a portion of the gas that went out to the balloon did not return to the pump.
4/26/2017

60. Check connections where gas tubing connects to IAB and to pump.
Observe for blood in the gas tubing. If even a slight amount were present, it would indicate a balloon rupture.
Do not resume pumping. Notify physician immediately and prepare for IAB removal.
Check connections where gas tubing connects to IAB and to pump.
Secure if loose.
Check for kinks, as they may trap gas in the IAB.
If water is present in the gas tubing, remove the condensation. Pushing the helium through the water during inflation and deflation slows down gas transition. If gas transition is prolonged too much, it can create alarms.
4/26/2017

61. Abnormal Waveform Variation: High Pressure / Kinked Line Alarm
Note that the plateau pressure is still greater than 250mmHg when it is time to deflate.
This indicates that not all of the gas could enter the balloon.
It is generally due to a kink in the catheter, either internal to the patient or external.
4/26/2017

62. Reposition patient. Keep affected leg straight
Reposition patient. Keep affected leg straight. Use rolled towel under hip to hyperextend hip.
Apply slight traction to the catheter if suspect kinking at the insertion site or in the artery.
3. Introducer sheath may be kinked which in turn is kinking the balloon. Suspect this particularly if placement of the sheath was difficult. Pull sheath back or rotate sheath a partial turn.
4/26/2017

63. Check placement of the balloon; it may be too high or too low.
IAB may be partially wrapped if alarm occurs shortly after insertion. Take steps to facilitate unwrapping (consult IAB manufacturer).
The balloon may be too large for the patient. Reduce the helium volume the balloon is inflated with. It is recommended to not reduce the volume below 2/3 of maximum. For example, do not decrease volume in a 40cc IAB below 27cc.
4/26/2017

64. Abnormal Waveform Variation: High Baseline / Fill Pressure
Indicates too much gas in the system.
4/26/2017

65. Check for intermittent obstruction of gas lumen. Overfill of system.
This condition may occur during ascent (an upward slope) in air transport since gas expands as you go up in altitude (elevation).
Reset the alarm and restart pumping.
The volume will be adjusted automatically for current barometric pressure.
In the AutoCAT, ensure that the tubing to the condensation bottle (located behind the helium tank) is not kinked.
4/26/2017

66. Potential Side Effects and Complications
Bleeding at the insertion site
Thrombocytopenia
Immobility of the balloon catheter
Balloon leak
Infection
Compartment syndrome
4/26/2017

67. IABP COMPLICATIONS
􀂾 Aortic dissection during insertion 􀂾 Reduction of platelets, RBC destruction 􀂾 Peripheral emboli 􀂾 Balloon rupture with gas embolus 􀂾 Renal failure (balloon occlusion of renal artery) 􀂾 Vascular insufficiency of catheterized limb
4/26/2017

68. Complications of IABP
The following patients are at the greatest risk of developing complications associated with IABP:
Peripheral vascular disease (PVD), female, diabetic, HTN, smokers, obese, high SVR, shock
4/26/2017

69. Complications of IABP
Aortic wall dissection, rupture or local vascular injury
Care as indicated
Emboli: thrombus, plaque or air
Administer 100% oxygen and intubate for significant respiratory distress or refractory hypoxemia. Oxygen may reduce bubble size by increasing the gradient for nitrogen to move out.
Promptly place patient in Trendelenburg (head down) position and rotate toward the left lateral decubitus position. This maneuver helps trap air in the apex of the ventricle, prevents its ejection into the pulmonary arterial system, and maintains right ventricular output.
Maintain systemic arterial pressure with fluid resuscitation and vasopressors/beta-adrenergic agents if necessary.
Consider transfer to a hyperbaric chamber. Potential benefits of this therapy include (1) compression of existing air bubbles, (2) establishment of a high diffusion gradient to speed dissolution of existing bubbles, and (3) improved oxygenation of ischemic tissues and lowered intracranial pressure.
Circulatory collapse should be addressed with CPR and consideration of more invasive procedures as described above.
4/26/2017

70. Treatment of an air embolism is as follows
Administer 100% oxygen and intubate for significant respiratory distress or refractory hypoxemia.
Oxygen may reduce bubble size by increasing the gradient for nitrogen to move out.
Promptly place patient in Trendelenburg (head down) position and rotate toward the left lateral decubitus position.
This maneuver helps trap air in the apex of the ventricle, prevents its ejection into the pulmonary arterial system, and maintains right ventricular output.
4/26/2017

71. Complications of IABP
IABP Rupture: Helium embolus or catheter entrapment (take or catch as if in a snare or trap)
COFFEE GROUNDS seen in the drive line is a precursor to a rupture
NOTIFY RT & PHYSICIAN!!!!!
IF THERE IS A FLAGRANT (bad or offensive) RUPURE OF THE IABP CLAMP THE GAS LINE!!!!!
4/26/2017

72. Complications of IABP Infection Check catheter insertion site often
STRICT ASEPTIC TECHNIQUE
Restrict movement while IABP in place
4/26/2017

73. Complications of IABP Obstruction Malposition
Too high – obstruction of left subclavian, carotids
CHECK LEFT RADIAL ARTERY PULSE
Too low – obstruction of renal and mesenteric arteries
MONITOR URINE OUTPUT
4/26/2017

74. Complications of IABP Compromised circulation due to catheter Ischemia
Routine nursing care and monitoring
Compartment syndrome
Rare complication seen in the LE (lupus erythematosus) , usually related to infection
Monitor calf circumference
4/26/2017

75. Complications of IABP Hematologic ALL PATIENTS Typed & Crossmatched!!!
Bleeding
REMOVE THE DRESSING!!!
PUT ON STERILE GLOVES!!!
HOLD PRESSURE!!!
Thrombocytopenia
Routine monitoring
4/26/2017

76. Zero Baseline (on console) Balloon Pressure Baseline Rapid Inflation
Peak Inflation Artifact
Balloon Pressure Plateau (IAB fully inflated)
Rapid Deflation
Balloon Deflation Artifact
Return to Baseline (IAB fully deflated)
Duration of Balloon Cycle
4/26/2017

77. Successful surgery for perforation of the thoracic aorta caused by the
European Journal of Cardio-thoracic Surgery 11 (1997) 1176–1179
Case report
Successful surgery for perforation of the thoracic aorta caused by the
tip of an intra-aortic balloon pump
Thomas Wolff *, Peter Stulz
Klinik fu¨r Herz- und Thoraxchirurgie, Kantonsspital, Spitalstrasse 21, CH-4031 Basel, Switzerland
We describe a case of perforation of the thoracic aorta caused by the tip of an intra-aortic balloon pump. The perforation was
confirmed by computed tomography (CT) scan and immediate surgical repair was successful. Vascular injury due to the insertion
of an intra-aortic balloon pump is quite common but is predominantly confined to limb ischemia or injury to the femoral or iliac
artery. Iatrogenic aortic perforation leading to significant bleeding is much less common and usually fatal. © 1997 Elsevier Science
B.V.Keywords: Aortic injury; Intra-aortic balloon pump; Complication
4/26/2017

78. Circ J 2002; 66: 423 –424
Perforation of the Descending Aorta by the Tip of an Intra-Aortic Balloon Pump Catheter
Ryo Shiraishi, MD*; Yukio Okazaki, MD; Kozo Naito, MD; Tsuyoshi Itoh, MD
Perforation of the proximal descending aorta occurred in a patient on intra-aortic balloon pump (IABP) supportafter emergency coronary intervention for acute myocardial infarction. The IABP catheter was inserted under fluoroscopic guidance into the right femoral artery without difficulty, but after 8 h on IABP support the patient
went into shock with a left hemothorax. Emergency surgery was performed with cardiopulmonary bypass and a perforation of the proximal descending aorta with active bleeding was found and successfully repaired. A distorted descending aorta in which the IABP catheter was kinked, as in the aortic arch, was discovered during
surgery and confirmed postoperatively with 3-dimensional computed tomography scans, particularly in the lateral view. Not only the antero-posterior but also the lateral fluoroscopic view is recommended to prevent aortic perforation by a kinked IABP catheter. (Circ J 2002; 66: 423 –424)
4/26/2017

79. Thrombosis of the Abdominal Aorta
Heart Inst J 1995;22: 202-3J
Thrombosis of the Abdominal Aorta
Elisabeth Leude, MD et al
A Rare Complication of the lntraaortic Balloon Pumping Device
We describe a patient who died due to thrombosis of the abdominal aorta and its branches after placement of an intraaortic balloon pumping device. This rare complication, which occurred despite careful insertion technique, underscores the need to select balloon
size as a function of the individual patient's morphology. (C omplication rates associated with the use of an intraaortic balloon pump(IABP) range from 10% to 20%.'-5 Trauma-related complications are themost frequent, including dissection, perforation, and thromboembolism.We describe a patient who died of thrombosis of the abdominal aorta and itsbranches subsequent to intraaortic balloon pumping. To our knowledge, this complication has been reported only once before in the literature.
4/26/2017

80. Conclusions
1.The consistent application of intra-aortic balloon pump support of patients with coronary artery disease and its complications has provided a therapeutic platform for direct surgical intervention on otherwise unstable patients with cardiac ischemia, heart failure, and shock.
This integrated approach to the treatment of patients with coronary artery disease has profoundly affected how this disease process is managed throughout the world.
4/26/2017

81. Maintain systemic arterial pressure with fluid resuscitation and vasopressors/beta-adrenergic agents if necessary.
Consider transfer to a hyperbaric chamber. Potential benefits of this therapy include (1) compression of existing air bubbles, (2) establishment of a high diffusion gradient to speed dissolution of existing bubbles, and (3) improved oxygenation of ischemic tissues and lowered intracranial pressure.
Circulatory collapse should be addressed with CPR and consideration of more invasive procedures
4/26/2017

82. Thank you
4/26/2017