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 pt’s 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