INTRA-AORTIC BALLOON PUMPS

 

Physiology:

1.†† Inflates after AV closure, deflates just before AV opening.

2.†† Decreases SAP, PCW, MAP 20%, DBP 30%, increases CO 20%.

3.†† Majority of benefit from reduced myocardial oxygen demand.

 

Indications:

1.†† Myocardial infarction

a.††††††††††† cardiogenic shock

b.††††††††††† mechanical complication (MR, VSD)

c.††††††††††† incessant ventrical arrhythmias w/ HD instability

d.††††††††††† refractory post-MI angina

2.†† Unstable angina

3.†† High-risk angioplasty or CABG

4.†† Refractory CHF- bridge to cardiac transplant

 

Contraindications:

1.†† Aortic insufficiency

2.†† Dissecting aortic aneurysm

3.†† Significant coagulopathy

4.†† Severe bilat PVD

5.†† Bilat fem-pop bypass grafts

6.†† Sepsis

 

Complications: Risk higher in ptís w/ PVD, DM, smoking, women.

1.††††† Thrombocytopenia

2.†† Bleeding:arterial perforation, pseudoaneurysm

3.†† Limb ischemia: dissection, thromboembolism, cholesterol embolism.

 

Zaacks et al. J Crit Illness. 12(7): 424-435, 1997