Case Report

Patient Case Presentation

• A 57 years old man with typical chest pain

• 247 code (Cath-Lab)

• PCI of RCA

• Loss of Consciousness and Intubation

• Cardiac Arrest and CPR

• IABP Placement

• Infusion Levofed

• Operation Room

Vital Sign

• BP = 80/50

• HR = 110

• O2Sat = 92%

Lab Test

• Na = 141
• K = 2.8
• Hb = 11.9
• BS = 255
• Lactat = 5.5
• ABG
  • PH = 7.13
  • PO₂ = 87
  • PCO₂ = 54
  • HCO₃ = 18
  • BE = -11

Preoperation TEE

• EF = 10-15%

• Moderate-Sever MR

• No PE

Intra-aortic Balloon Pump

Indications and Contraindications

Arterial Waveforms During IABP assist

Indications for Placement

• In the cardiac catheterization laboratory

  • High-grade lesion of proximal coronary vessels
  • MI occurs after an intervention

• LV failure despite moderate-to-high-dose inotropic support

• Evidence of ongoing regional myocardial ischemia

Contraindications to Placement

• Aortic Insufficiency
• Sepsis
• Sever Vascular Disease

Functional Design

• The balloon inflates during diastole

• Increasing aortic diastole pressure

• Balloon inflation improves coronary perfusion pressure

• During early systole, rapid balloon deflation reduces LV afterload

IABP Placement

• The balloon is ideally positioned so that its tip is at the junction of the descending aorta and the aortic arch

• Radiographically the tip should lie between the anterior portion of the second intercostal space and the first lumbar vertebra

• When the IABP is placed intraoperatively, TEE can confirm proper tip location before initiation of balloon assitance

IABP Control

• Synchronization of the IABP

  • Cardiac rhythm (EKG - Arterial Pressure waveform)

• Timing of Balloon Inflation and Deflation

  • It is important to time the onset of the pressure rise caused by balloon inflation with the dicrotic notch of the arterial waveform

• Ratio of Native Ventricle Pulsations to IABP Pulsation

• Stroke Volume of the Balloon

Manipulation of Timing

Normal Size Balloon

Balloon Too Large

Balloon Too Small

IABP Weaning

• Weaning is done primarily by gradually decreasing the ratio of augmented to native heartbeats

Management of Anticoagulation During IABP Assistance

• During extended IABP use, anticoagulation is generally indicated

• If heparin is used, adequate anticoagulation should be confirmed every 4 to 6 hours with ACT or PTT

Complication

• Limb Ischemia
• Compartment Syndrome
• Mesenteric Infarction
• Aortic Perforation
• Aortic Dissection

IABP Complications

Risk Factors for Complication

• Peripheral Vascular Disease
• Female Gender
• Tobacco Smoking
• DM

Little old ladies and balloon pump
don’t mix