Why helium is used for balloon inflation?
Helium is used for inflation because its low viscosity facilitates rapid transfer in and out of the balloon, and because it absorbs very rapidly in blood in the case of balloon rupture. Timing of balloon inflation and deflation is based on electrocardiogram (ECG) or pressure triggers.
What is an intra-aortic balloon pump (IABP)?
An intra-aortic balloon pump (IABP) is a device that helps your heart pump more blood. It looks like a long, skinny balloon and inflates and deflates. An IABP stays in place for only a few days. Healthcare providers typically use the device when you’re in the hospital after a surgery or cardiac event.
What is the structure of IABP?
The IABP consists of a balloon catheter and a pump console to control the balloon. The catheter is a double-lumen 7.5–8.0 French catheter with a polyethylene balloon attached at its distal end with one lumen of the catheter attached to the pump in order to inflate the balloon with gas.
How many lumens does the IABP have?
The IABP has two lumens: one for the inflation and deflation of the balloon with helium and one for the measurement of aortic pressure.
Which gas is used in IABP machine?
Al-can manufactures first time in India High Pressure Aluminium Helium Gas Cylinders which is used in IABP (India Aortic Balloon Pump) for cardiac in intensive care unit.
What are IABP filled with?
The IABP consists in a polyethylene or PU balloon mounted at the distal tip of a large bore catheter. The catheter is generally inserted into the aorta through the femoral artery in the leg. Outside the catheter is connected to a console that inflates the balloon with helium.
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.
How does IABP reduce afterload?
The intra-aortic balloon, by inflating during diastole, displaces blood volume from the thoracic aorta. In systole, as the balloon rapidly deflates, this creates a dead space, effectively reducing afterload for myocardial ejection and improving forward flow from the left ventricle.
Does IABP need heparin?
Introduction. Intra-aortic balloon pumps (IABPs) are a form of mechanical circulatory support used to enhance cardiac output and increase coronary artery perfusion. Heparin is often used in patients with an IABP, as early registry data have shown an increased risk of limb ischemia and other thrombotic events [1].
How do you zero a balloon pump?
4:5322:56Cardiosave IABP Tutorial - YouTubeYouTubeStart of suggested clipEnd of suggested clipYou do bad that exactly the same way you do with every other transducer. You open it to atmosphere.MoreYou do bad that exactly the same way you do with every other transducer. You open it to atmosphere. And then to zero it you will hold down this calibrate pressure button for two seconds.
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.
What is augmented pressure on IABP?
During IABP augmentation, the DPTI is. increased as the aortic diastolic blood pressure is increased. and the left ventricular diastolic pressure is decreased.
What does IABP 1 1 mean?
The amount of aid a balloon pump provides can be quantified as a ratio of native beats to assisted beats. Full support is at a ratio of 1:1; that is, every beat is augmented by the IABP.
Why is diastolic pressure important with a balloon pump?
Augmentation of diastolic pressure during balloon inflation contributes to the coronary circulation and the presystolic deflation of the balloon reduces the resistance to systolic output. Consequently, the myocardial work is reduced.
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.
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 do 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 IABP procedure?
IABP therapy involves inserting the balloon-tipped catheter into a blood vessel and advancing it to the heart. Usually, this happens during a heart-related surgery. In an emergency, a medical team may insert it at your bedside. Your healthcare provider can tell you exactly what to expect.
How long can a balloon pump stay in?
How long can an intra-aortic balloon pump stay in? An intra-aortic balloon pump usually only stays in place for a few days. However, your provider may keep it in place for up to 30 days, or sometimes longer. An intra-aortic balloon pump is a device that controls blood flow through your heart.
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 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.
What are the mechanical circulatory support devices?
To date, four types of mechanical circulatory support devices exist that include Intra-aortic balloon pump (IABP), non-IABP ventricular circulatory assist devices, extracorporeal membrane oxygenation devices, and non-percutaneous ventricular assist devices. Intra-aortic balloon pump is the simplest, cost-effective, easy to implant and explant in the coronary catheterization laboratory by an interventional cardiologist and can effectively be managed in an intensive care unit by an intensivist.[2] Although IABP has a modest hemodynamic beneficial effect compared with novel, advanced mechanical circulatory support devices, it has a better safety profile, relative simplicity to use, and the beneficial cardiovascular physiological impact. These features make IABP a frequently used circulatory support device in patients requiring hemodynamic support either in cardiogenic shock or at risk of hemodynamic decompensation during a high-risk coronary intervention. However, currently available evidence related to the use of IABP is in constant flux. Therefore, it is important to review the safety and efficacy of IABP in various clinical conditions and appraise the health care providers of current evidence-based literature related to IABP. This article reviews the physiological and hemodynamic effects of IABP on the cardiovascular system as well as the safety and efficacy of its use in various cardiovascular clinical conditions.
What is the percentage of ischemia?
Major limb ischemia (loss of pulse, loss of sensation, or abnormal temperature or pallor limb necessitating intervention, arterial repair or amputation) 0.5%
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]
Why do IABPs use helium?
Helium is used because its low viscosity allows it to travel quickly through the long connecting tubes, and has a lower risk than air of causing an embolism should the balloon rupture.
How does IABP work?
How Does It Work? The IABP is connected to a long catheter. The balloon at the end of the catheter is sitting right in front of the heart in the aorta. The catheter is inserted via the left or right groin (femoral artery).
How long does IABP last?
It will only be used for a few days, up to one week in rare instances. The longer the IABP stays in place the higher the risk for infection.
What is an intra aortic balloon pump?
The Intra-aortic balloon pump (IABP) is a mechanical device that increases oxygen perfusion in the heart and the heart muscles, while at the same time increasing cardiac output (blood flow). Increasing cardiac output increases coronary blood flow and therefore myocardial oxygen delivery (oxygen delivery to the heart).
Why is helium used in balloons?
Helium is used for inflation because its low viscosity facilitates rapid transfer in and out of the balloon, and because it absorbs very rapidly in blood in the case of balloon rupture . Timing of balloon inflation and deflation is based on electrocardiogram (ECG) or pressure triggers.
What is an IABP?
The intra-aortic balloon pump (IABP) is a mechanical device initially used for perioperative cardiac failure, now also used for patients with preshock, severe congestive heart failure, and refractory angina. Patients who undergo insertion of intra-aortic balloon pumps can experience cerebrovascular events including ischemic stroke, TIA, and intracranial hemorrhage, as well as peripheral neurologic deficits (Honet et al., 1975; Hazelrigg et al., 1992; Ho et al., 2002). The transthoracic route of IABP introduction may predispose to peripheral neurologic deficits in the lower extremities resulting from limb ischemia (Hazelrigg et al., 1992). Honet et al. reported on a series of 39 patients with IABP, six of whom had significant neurologic deficits in one or both legs, ranging from a foot drop to almost total paralysis associated with the use of IABP. In these patients, IABP insertion was via the femoral artery and the neurologic deficits have been hypothesized to occur secondary to obstruction to blood flow or thromboembolism in the femoral artery (Honet et al., 1975 ). Stroke has been reported to occur in 2.5% of patients with IABP ( Hazelrigg et al., 1992). Mechanisms associated with stroke in patients with IABP include thromboembolism associated with mobile atheroma in the thoracic aorta (Ho et al., 2002 ), perioperative and delayed spontaneous thromboembolism ( Hazelrigg et al., 1992), and cerebral air embolism (Cruz-Flores et al., 2005 ).
How much does IABP increase cardiac output?
With an IABP, there appears to be a 20% to 30% increase in cardiac output in patients with low-output syndromes and a significant amount of afterload reduction as demonstrated in reduction of mitral regurgitation. Direct measurement of coronary blood flow during IABP function has demonstrated augmentation in nondiseased and post-angioplasty vessels, but no increase in vessels distal to significant stenosis.
What is IABP counterpulsation?
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. Deflation of the balloon just before systole (end diastole on the arterial pressure tracing) results in decreased ventricular afterload, which decreases myocardial oxygen consumption and increases cardiac output. These effects are illustrated in Figure 12-5. An example of the arterial waveform during correctly timed intra-aortic balloon counterpulsation is shown in Figure 12-6.
How many lumens does an IABP have?
The IABP has two lumens: one for the inflation and deflation of the balloon with helium and one for the measurement of aortic pressure. The catheter is connected to an external console that has a pneumatic pump, a microprocessor for timing inflation and deflation, and a screen that continuously displays the electrocardiogram (ECG), arterial blood pressure, and balloon pressure. The ECG is obtained from electrodes attached to the patient or by “slaving” the ECG from the patient monitor. The balloon is inflated during diastole and deflated just prior to ventricular ejection (Fig. 22-1 ).
How does balloon pump counterpulsation affect myocardial output?
Intra-aortic balloon pump counterpulsation increases myocardial oxygen supply and decreases myocardial oxygen demand. 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. Deflation of the balloon just before systole (end diastole on the arterial pressure tracing) results in decreased ventricular afterload, which decreases myocardial oxygen consumption and increases cardiac output. In patients with low-output states, cardiac output may be increased by 20–30%. These effects are illustrated in Fig. 9-1. An example of the arterial waveform during correctly timed intra-aortic balloon counterpulsation is shown in Fig. 9-2.
Why is the IABP placed too high?
More often than not, the IABP is put in as an emergency procedure without full knowledge of aortic caliber. Arch aortography performed at the time of balloon placement should identify the left common carotid and subclavian artery origins but will not always give an accurate estimation of aortic diameter. If the IABP is placed too high, there may be occlusion of the left subclavian or carotid arteries resulting in possible cerebral ischemia, stroke, or decreased upper extremity perfusion. Migration secondary to vessel tortuosity or positioning the IABP too low may result in malperfusion to the mesenteric and renal arteries. In both cases, the IABP will need to be repositioned appropriately and in some cases a new balloon sterilely inserted.
Why is an IABP inserted?
Two reasons: first, to help perfuse the coronary arteries, when they are nearly closed by tight lesions. If you try to visualize the cardiac cycle, think of the heart during diastole: the chamber walls open up, and on the left side of the heart, the valve leading from the LV to the aorta – the aortic valve – flips shut. The aorta has just been filled by the previous systolic contraction, and now with the aortic valve closed, it rebounds a little, like a garden hose with a pulse of water going through it – the walls stretch a bit with each systole, and then spring back a bit, creating a small backwards pressure towards the heart. The openings leading to the coronary arteries are actually in the wall of the aorta, just above the aortic valve, and the arteries fill passively during diastole. The balloon is timed to inflate at the end of diastole, creating a forcible pressure backwards along the aortic arch, pushing blood actively through the coronary arteries.
How is a balloon inserted? Who does the procedure?
An IABP is inserted by an interventional cardiologist, usually in the cath lab under fluoroscopy, using much the same technique as any central line placement. Very rarely the balloon is put in at the bedside, but this is usually in a near-code situation – it’s been many years since I’ve seen this done. Careful placement is needed to avoid placing the balloon too high or low, and the patient must have an x-ray to confirm proper placement of the balloon tip. This can be read by the balloon techs, but has to be confirmed by a knowledgeable doc.
What is diastolic augmentation?
Inflation of the balloon during diastole increases coronary perfusion pressure which is normally derived from the end-diastolic aortic root pressure.
What is stable angina? Unstable angina?
Unstable angina is the pain the patients get as the coronary lesions get tighter. This angina can strike spontaneously, without any exertion, and represents worsening CAD.
What is balloon timing?
Timing is everything in life, and the IABP is no exception. If you think about it even for a moment, you’ll realize that if the balloon is still inflated in the aorta, when the heart is trying to pump blood into that aorta – well, that would be a bad thing. So the timing of both inflation and deflation must be carefully looked after.
Why does the balloon inflate at the dicrotic notch?
It turns out that the anatomical openings – the ostea – leading to the coronary arteries are in the wall of the aorta, just above the valve, and at the end of diastole the aorta rebounds a little bit, and the coronaries perfuse – passively. Now, if your ischemic patient needed more than just passive perfusion – what could you do? Inflate the balloon. How do you know when to inflate? It turns out that the dicrotic notch, coming at the end of diastole, indicates exactly the event we want – the closure of the aortic valve. Once the valve is closed, the balloon inflates, and blood is forcibly pushed backwards along the aortic arch, and into the coronary arteries under pressure, improving perfusion.
Why do we use the arterial wave for timing?
Simple: we use the arterial wave to look for the dicrotic notch, to use as the marker for inflating the balloon. Use the inflation knob to move the inflation wave leftwards, until it meets the dicrotic notch.
