Intra-Aortic Balloon Pump
In short, this thing is a catheter with a helium-filled balloon on the end, threaded into one's aorta, rigged to fill and empty in sequence with the cardiac cycle. Yes, it's a very strange thing to have in your aorta. An no, it's not at all uncomfortable - Alex Yartsev
image by: IU Health LifeLine
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Another Hole in the Ballon (-Pump)!
In the late 1960's the technology of counter-pulsation by using an intra-aortic balloon pump (IABP) was introduced into clinical work. Based on the principle of diastolic inflation and systolic deflation, IABP counter-pulsation improves diastolic coronary artery blood flow and decreases left ventricular afterload. Up to the year 2009, 2012 respectively, the usage of an IABP in patients with ST-segment elevation myocardial infarction and cardiogenic shock was considered a class IC recommendation (reminder: levels of evidence).
Since then a couple of well conducted, larger trials have failed to show a positive impact of IABP especially on mortality. In regards of the most recent meta-analysis…
Resources
Intra‐aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock
Available evidence suggests that IABP may have a beneficial effect on some haemodynamic parameters. However, this did not result in survival benefits so there is no convincing randomised data to support the use of IABP in infarct‐related cardiogenic shock.
Anatomy of the intra aortic balloon pump
In short, this thing is a catheter with a helium-filled balloon on the end, threaded into one's aorta, rigged to fill and empty in sequence with the cardiac cycle.
Double Balloon Pump Failure
Two recent trials question the ongoing use of intra-aortic balloon pumps: in patients with acute myocardial infarction with cardiogenic shock undergoing revascularisation, and patients with poor left ventricular function undergoing coronary artery bypass surgery.
How a balloon pump helps the heart
The balloon pump is a short term device, useful for periods of a few hours up to two weeks. It decreases the workload of the heart, thus decreasing the oxygen demand or MVO2, and increases the circulation of the coronary arteries, thus increasing oxygen delivery to all cardiac cells.
iabp: intra aortic balloon pumps
In the 1960s, cardiac surgeon Dr Adrian Kantrowitz pioneered the intra-aortic balloon pump – a surgically implantable device that provided mechanical circulatory support in patients following cardiac surgery. These days, it is a widely used, invaluable piece of equipment that is often inserted and removed in the intensive care unit.
iabp: intra aortic balloon pumps
In the 1960s, cardiac surgeon Dr Adrian Kantrowitz pioneered the intra-aortic balloon pump – a surgically implantable device that provided mechanical circulatory support in patients following cardiac surgery. These days, it is a widely used, invaluable piece of equipment that is often inserted and removed in the intensive care unit.
Intra-aortic balloon pump: is the tide turning?
However, after years of honest service, the IABP has been struck by a scientific thunderstorm called “SHOCK II”, which has seriously questioned the use of this assist device in cardiogenic shock complicating acute myocardial infarction.
Intra-Aortic Balloon Pumping: In Search of the Last Remaining Indication?
Intra-aortic balloon pumping (IABP) has been the most widely used system for hemodynamic support for several decades. The underlying functional idea is to improve coronary perfusion and left ventricular output by diastolic augmentation and afterload reduction. Because registry data indicated a mortality benefit, former international guidelines gave a Class I recommendation in favor of IABP in patients with CS.
Origins of Intraaortic Balloon Pumping
Any new idea, if it is to succeed, requires the courage and depth of understanding of its inventor to pursue the thought to its conclusion. The least challenges in the development of IABP were solving the many technical problems. More formidable were the intrainstitutional political agendas and their obstructive consequences. That IABP was not aborted in its infancy is witness to the remarkable support to us from the National Institutes of Health,...
Replacing Balloon Pumps with VADs: When is the Right Time?
Since the Impella 2.5 was designed for use on a short-term basis, Dr. Samuels said, “Some patients will go from a balloon pump to the Impella to a permanent VAD.”
The effectiveness of intra-aortic balloon pump for myocardial infarction in patients with or without cardiogenic shock: a meta-analysis and systematic review
Future studies comprising of large, multicentric, prospective randomized trials should be undertaken to validate the current data and also to confirm or disprove its efficacy in patients with different diagnosis, including patients with high to moderate risk of CS and patients with AMI with and without CS.
What is an Intra-Aortic Balloon Pump (IABP)?
These are just the basics of this useful counterpulsation device.
Another Hole in the Ballon (-Pump)!
Up to the year 2009, 2012 respectively, the usage of an IABP in patients with ST-segment elevation myocardial infarction and cardiogenic shock was considered a class IC recommendation (reminder: levels of evidence). Since then a couple of well conducted, larger trials have failed to show a positive impact of IABP especially on mortality. In regards of the most recent meta-analysis in JAMA we provide a short overview of the most important publications. It's interesting to see that the balloons undermining started with a meta-analysis and for the the time being ends with one.
Life in the Fastlane
The IABP can be used whenever there is cardiac pump failure if: it may resolve spontaneously, or a corrective procedure is planned. In other words, there has to be some hope of the patient being able to survive without an IABP in the future.
StatPearls
Various mechanical circulatory devices have been developed to mitigate the adverse outcomes of cardiogenic shock until treating the underlying cause. 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
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