Where does inflation occur in a balloon?
In normal inflation-deflation timing, balloon inflation occurs at the onset of diastole, after aortic valve closure; deflation occurs during isovolumetric contraction, just before the aortic valve opens. In a properly timed waveform, as shown, the inflation point lies at or slightly above the dicrotic notch.
What causes early inflation of the IABP before the dicrotic notch?
Aortic pressure waveform demonstrating early inflation of the IABP (arrow) prior to the dicrotic notch (DN) and prior to the closure of the aortic valve. There is a rapid rise in augmented diastolic pressure (*) with the aortic valve still open, which causes a dramatic increase in afterload and reduces cardiac output.
When should the IABP inflate and deflate?
For optimal efficacy, the IABP should inflate during early diastole (after the aortic valve closes, which is identified by the dicrotic notch) and deflate just prior to systole (just before the aortic valve opens).
When does a balloon inflate during diastole?
Balloon inflation occurs during diastole, beginning with aortic valve closure. The balloon remains inflated during diastole, while its rapid deflation is set to be initiated a few milliseconds before the onset of left ventricular ejection.
What triggers balloon inflation in IABP?
The most commonly used triggers are the ECG waveform and the systemic arterial pressure waveform. The balloon inflates with the onset of diastole, which corresponds with the middle of the T-wave. The balloon deflates at the onset of LV systole and this corresponds to the peak of the R-wave.
What occurs during inflation of IABP?
IABP counterpulsation increases myocardial oxygen supply and decreases myocardial oxygen demand. IABP balloon inflation at the onset of diastole (at the dicrotic notch on the central arterial pressure tracing) results in augmentation of diastolic pressure, which increases coronary artery (and systemic) perfusion.
When should IABP deflation occur?
Deflation should be set to occur near the end of diastole during isovolumetric contraction immediately before systole (4). Such determination of proper deflation timing is done by evaluating the assisted aortic end diastolic pressure to ensure that it is less than the unassisted aortic end diastolic pressure.
Why does IABP inflate during diastole?
The balloon inflates in diastole, displacing aortic blood both into the systemic circulation and into the coronary arteries. The balloon deflates before systole, decreasing aortic pressure. Diastolic augmentation thus improves coronary blood flow.
What is the augmented pressure on IABP?
The IABP augments coronary per- fusion pressure (CPP) by increasing aortic diastolic pres- sure (DBP) and decreasing the left ventricular end-diastolic pressure (LVEDP) in the form of the equation: CPP = DBP − LVEDP.
What happens when the IABP balloon deflates late?
Late balloon deflation increases afterload. Poor diastolic augmentation results in suboptimal coronary perfusion.
What does Dicrotic notch represent?
The dicrotic notch The notch represents the nadir point that occurs immediately after the closure of the aortic valves and precedes the secondary dicrotic wave. The notch is frequently used as a marker for the end of the ventricular ejection period.
How do you time IABP?
1:2713:09Timing and triggering of the Intra-aortic Balloon Pump (IABP)YouTubeStart of suggested clipEnd of suggested clipThe after load against which the weakened heart is contracting the waveforms taken from the aorticMoreThe after load against which the weakened heart is contracting the waveforms taken from the aortic root arterial pressure can be used to determine the appropriateness of the timing of inflation.
What is a physiologic effect of late balloon deflation?
Q 4.3 What are the physiological effects? Late deflation of the IAB has these effects: There is no afterload reduction. The inflated balloon may actually impede left ventricular ejection and increase the afterload.
How much should IABP augment?
While in many clinical situations volume of 40 cc are appropriate, it should be said that too large IAB increases vascular morbidity whereas too small IAB reduces the cardiac benefit. 50 cc Balloon has been used in taller patients. Diastolic augmentation is maximized when stroke volume is equal to balloon volume.
How does a balloon pump increase cardiac output?
The IABP assists the heart indirectly by decreasing the afterload and augments diastolic aortic pressure with subsequent enhancement in diastolic blood flow resulting in better perfusion of the peripheral organ as well as a possible improvement in the coronary blood flow.
How does IABP increase cardiac output?
As it relaxes, blood flows into the coronary arteries to bring oxygen to the heart. An IABP allows blood to flow more easily into your coronary arteries. It also helps your heart pump more blood with each contraction. The balloon is inserted into your aorta.
Does balloon pump increase cardiac output?
Anatomic, Physiologic, and Hemodynamic Effects of IABP These hemodynamic changes improve the cardiac output by increasing stroke volume, particularly in patients with reduced left ventricular function.
What does the Dicrotic notch represent?
The dicrotic notch The notch represents the nadir point that occurs immediately after the closure of the aortic valves and precedes the secondary dicrotic wave. The notch is frequently used as a marker for the end of the ventricular ejection period.
How does an IABP work?
The intra-aortic balloon pump (IABP) reduces the workload on your heart, allowing your heart to pump more blood. The IABP is placed inside your aorta, the artery that takes blood from the heart to the rest of the body. The balloon on the end of the catheter inflates and deflates with the rhythm of your heart.
What is the lowest pressure seen in IABP?
The IABP should deflate just prior to the opening of the AV. Properly timed, this means that the balloon-augmented end-diastolic is the lowest pressure seen. In particular, the IABP-augmented end-diastolic is less than the native end-diastolic pressure. It also means that the IABP-assisted systolic (ie, the systole following IABP deflation) should be less than the native, non-assisted, systolic pressure. Truly, I do not know how much impedance is reduced by the balloon, compared with a native beat.
What is the goal of inflation?
1) The Goal of Inflation (during diastole) is to create a rapid rise in coronary artery diastolic pressure to allow perfusion of the LV subendocardium:
How is balloon inflation triggered?
Balloon inflation is triggered according to the patient’s electrocardiogram, blood pressure waveform, a pacemaker (if there is one), or by a preset internal rate. The intraaortic balloon is inflated with an inert gas (helium) that is easily absorbed into the bloodstream in case of balloon rupture. Figure 1.:
What is an IABP?
The intraaortic balloon pump (IABP) is the single most effective and widely used device for temporary mechanical assistance of the failing heart. Although the principles underlying IABP function are simple, various biologic factors often determine its performance in a particularly complicated way. We briefly describe the basic disciplines of counterpulsation by IABP and the induced hemodynamic changes while clarifying the biologic mechanisms that play a crucial role in the modification of IABP acute hemodynamic performance.
How does a balloon affect the aorta?
The resulting volume displacement and pressure changes within the aorta ex ert the salutary IABP effects. The gas enters the balloon chamber occupying a space within the aorta almost equal to its volume. The usual adult balloon volume ranges from 30–50 cc, whereas in children, it varies from 2.5–25 cc. The sudden occupation of space inside the balloon by the gas during inflation causes the blood that surrounds the balloon to be moved from its original position superiorly and inferiorly to the balloon. Because the volume in the aorta is suddenly increased, the intraaortic pressure increases sharply. On the other hand, deflation of the intraaortic balloon induces reverse events. A rapid reduction in aortic volume leads to a sudden fall in aortic pressure within that localized aortic area. Displacement of blood volume, both away from the balloon upon inflation and toward the balloon upon deflation, is the principal mechanism by which the intraaortic balloon pump affects the hemodynamic state.
How does IABP affect the heart?
However, the leading contribution of IABP treatment is from its metabolic effects, which tend to improve the cardiac energy balance a) by increasing oxygen supply to the ischemic myocardium and b) by reducing cardiac oxygen demand (consumption). The first objective is accomplished by the enhancement of coronary blood flow through an increase in aortic diastolic pressure, whereas the second is achieved by decreasing left ventricular (LV) afterload via a reduction in end diastolic and systolic aortic pressures.
What is an intraaortic balloon pump?
The intraaortic balloon pump (IABP) has emerged as the single most effective and widely used circulatory assist device for temporary mechanical assistance of the failing circulation. Although the initial indication for intraaortic balloon counterpulsation use was in patients with cardiogenic shock, encouraging clinical data extended its application to numerous other clinical situations such as preshock syndrome, threatening extension of myocardial infarction, unstable angina, intractable ventricular dysrrhythmias, septic shock, cardiac contusion, support during transport from community hospital, postsurgical myocardial dysfunction, prophylactic support during coronary interventions, and as a bridge for cardiac transplant. 1
Why does the intraaortic pressure increase?
Because the volume in the aorta is suddenly increased, the intraaortic pressure increases sharply. On the other hand, deflation of the intraaortic balloon induces reverse events. A rapid reduction in aortic volume leads to a sudden fall in aortic pressure within that localized aortic area.
When was counterpulsation first used?
The beginning of the widespread use of counterpulsation in clinical practice was the result of the pioneering work of Moulopoulos et al. 3 in 1962, who introduced the concept of counterpulsation by using an intraaortic balloon.
How does IABP work?
As the heart relaxes, the balloon inflates. It forces the blood back into the coronary arteries. These arteries can’t get adequate blood without a pump. When the heart shrinks, the balloon also shrinks. This shrinkage generates additional room in the aorta, which allows the heart to pump more blood. This process will reduce the stress on your heart. The pump will continue to expand and contract until it eliminates.
Why does the balloon pump inflate during diastole?
During the working, the intra-aortic balloon pump balloon expands and depresses due to the reverse pulsation process. In simple words, it inflates during diastole and depresses aggressively during systole. With the help of the vacuum effect, the systolic deflation reduces the afterload and indirectly improves the anterior blood flow to the heart. The pump inflates during the diastole process and boosts the coronary arteries’ blood flow through the retrograde blood flow. Together, these processes (systolic and diastole) reduce myocardial O2 need and increase myocardial O2 (oxygen) delivery.
What is an Intra-aortic Balloon Pump?
An intra-aortic balloon pump (IABP) is a mechanical machine that rises the oxygen (O2) perfusion to the heart and the heart’s muscle and also increases the blood flow (cardiac output). Increased cardiac output boosts the flow of the coronary blood, which increases the supply of O2 to the heart.
What are the risks for intra-aortic balloon pump therapy?
Treatment with IABP is beneficial. Sometimes it even saves lives. But it also has some risks that are given below:
How do I prepare for intra-aortic balloon pump treatment?
Before the treatment, you must talk with your healthcare provider. Your healthcare provider will provide detailed directions about your treatment.
Why is a transducer required for continuous blood pressure monitoring?
A transducer is compulsory for continuous blood pressure monitoring because the IABP uses a double notch in the aortic blood pressure curve to measure the time of expansion and contraction of the balloon.
What is the purpose of a balloon pump?
1) Balloon. The balloon uses to block the way of blood in the aorta at a specific point in time. That means it must be able to resist the pressure of the heart. It is made of a material that will not break or damage easily. This component of the intra-aortic balloon pump should be biocompatible.
How does IABP affect the heart?
The IABP assists the heart indirectly by decreasing the afterload and augments diastolic aortic pressure with subsequent enhancement in diastolic blood flow resulting in better perfusion of the peripheral organ as well as a possible improvement in the coronary blood flow. The intra-aortic balloon inflates during diastole synchronously with aortic valve closure and the appearance of a dicrotic notch resulting in the displacement of blood from the thoracic aorta into the peripheral circulation that is followed by rapid deflation before the onset of systole phase of the cardiac cycle. Theoretically, this results in improved diastolic pressure and reduced systolic aortic pressure by reducing the afterload, which subsequently results in decreased left ventricle wall stress reducing the myocardial oxygen demand. These hemodynamic changes improve the cardiac output by increasing stroke volume, particularly in patients with reduced left ventricular function.
How is an IABP catheter inserted?
The IABP catheter is inserted and advanced over the 0.018" guidewire to the proper positioning of the balloon in the aorta. The location of the intra-aortic balloon with its tip lying distal to the left subclavian artery and the proximal portion ending above the origin of renal arteries is considered as the ‘safe zone,’ and the confirmation of position can be by chest x-ray or fluoroscopy. Following guidewire removal, and the central lumen of the catheter is flushed and connected to the transducer to measure intra-aortic pressure. The IABP catheter gets connected to the extender catheter, which then connects to the IABP console. [14]
What is included in an intra aortic balloon pump kit?
Intra-aortic balloon pump kit: That includes an intra-aortic balloon pump system with an IABP catheter, arterial dilator, a guidewire, angiographic needle.
Does IABP help with ventricular failure?
IABP use may also help patients with acute right ventricular failure by reducing the right ventricular afterload by decreasing pulmonary artery pressure and left ventricular end-systolic and end-diastolic pressures and, as a result, improves the cardiac output. [5][6]
Does IABP increase aortic stiffness?
Stefanadis et al. demonstrated a 30% increase in aortic distensibility with IABP, thereby reducing the aortic stiffness constant, resulting in a 24% increase in cardiac index and a 31% reduction in myocardial oxygen demand.[3] In patients with systolic heart failure, IABP improves ventriculoarterial coupling ratio and consequently enhances stroke volume by reducing peripheral arterial elasticity without affecting the left ventricular end-systolic elastance. In these patients with low output, a reduction of end-systolic pressures, end-diastolic pressure, and volume of the left ventricle with IABP result in a leftward shift of pressure-volume loop with a reduced pressure-volume loop area suggesting a decrease myocardial oxygen demand. [4]
Do you need informed consent before IABP?
Prior to the insertion of IABP, informed consent is necessary with a clear explanation of the risks and benefits of IABP insertion.
Where is the angiographic needle inserted?
After the implementation of sterile techniques to prepare the femoral catheterization site and application of local anesthesia, the angiographic needle is inserted into the common femoral artery below the inguinal ligament at an angle of 45 degrees or less. The fluoroscopic device can be used to ensure the location of an angiographic needle into the common femoral artery as the arterial puncture above the inguinal ligament is strongly associated with retroperitoneal hemorrhage, and arterial puncture at or below the femoral artery bifurcation is associated with acute limb ischemia. After ensuring adequate placement of the radiographic needle, the J-tip of 0.035" guidewire gets inserted and advanced through the angiographic needle into the femoral artery. The angiographic needle is removed over the guidewire while keeping the guidewire in place. A small incision with the help of the blade is made in the skin at the site of insertion of the guidewire to facilitate insertion of the sheath introducer. With the help of an introducer dilator to be inserted over the guidewire and advanced it in a rotary fashion into the femoral artery, the sheath tract can further be prepared to facilitate the insertion of the introducer sheath into the artery. The introducer sheath gets placed over the guidewire, and then 0.035 guidewire is removed while leaving the introducer sheath in the arterial lumen. It is followed by the insertion of a J-tube of the 0.018" guidewire (IABP guide wire) through the introducer sheath and advanced into the thoracic aorta.
What happens after struggling all night with the balloon pump?
After struggling all night optimizing the timing of the balloon pump, the patient develops atrial fibrillation with intermittent ventricular ectopy.
What does suboptimal augmentation of DBP mean?
Suboptimal augmentation of DBP (peak C) means that coronary perfusion may be inadequate.
What is the peak of diastolic augmentation?
Diastolic augmentation (peak B) encroaches on the peak corresponding to unassisted systole (peak A) – the two peaks have merged and are barely distinguishable.
Why does myocardial oxygen consumption increase?
Myocardial oxygen consumption will increase because the left ventricle experiences a longer period of isovolumetric contraction (when most myocardial oxygen consumption occurs) and has to contract against greater resistance (afterload).
What is the effect of premature closure of the aortic valve and possible aortic regurgi?
Premature closure of the aortic valve and possible aortic regurgitation, thus impairing left ventricular emptying. There may be an increase in LVEDV, LVEDP and PCWP.
What is the upstroke of assisted systolic BP?
The upstroke of assisted systolic BP (peak F) has a gentle gradient resulting in a prolonged rise.
What causes angina in the heart?
inadequate coronary perfusion, with the potential for retrograde coronary blood flow. This may result in angina due to decreased myocardial oxygen supply.
How to prepare an IAB?
1. Ensure balloon has negative pressure applied with one way valve in place before removing it from holder. 2. always plug pump into electrical outlet. 3. turn helium on. 4. obtain an EKG signal. 5. set up and prime transducer. 6. Connect gas line to the balloon (after removal of one-way valve)
Where does gas go when it is shuttled into a balloon?
as gas is shuttled into the balloon it occupies a space within the aorta equal to its volume.
What happens to aortic valves after load?
resistance to systolic ejection with greatly increased after load. This will cause premature closure of aortic valve, reduction of LV emptying and reduction of CO, increase in myocardial workload and consumption.
What wave does pump recognize?
based on duration of inflation during systole. Pump computer recognizes R wave to R wave on EKG.
Does balloon volume decrease after load reduction?
balloon volume is decreased by a small portion. This does not cause rapid after load reduction in the heart.
How many lumens are used to shuttle gas to and from a balloon?
2. One lumen is used to shuttle gas to and from the balloon.
What happens to aortic diastolic pressure at the onset of diastole?
At the onset of diastole, increases aortic diastolic pressure to a level higher than systolic pressure
How long should pressure be maintained on a puncture site?
2. Pressure must be maintained on the puncture site for 30to 60 minutes with frequent assessment of distal pulses.
Why is the puncture site held distal to the puncture site?
Held distal to the puncture site to allow potential clot/thrombi to be expelled.