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