Term
| Intra-aortic balloon pump (IABP) |
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Definition
| Mechanical cardiac assist device that benefits patients with actual or potential life-threatening circulatory problems |
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Term
| Intra-aortic balloon counter-pulsation (IABC) |
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Definition
–Reduces the resistance to left ventricular ejection and increases coronary and systemic blood flow
–Circulatory support provided by a balloon inserted into the thoracic aorta, inflated during diastole and deflated during systole. |
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Term
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Definition
‒At the onset of diastole, balloon inflation increases aortic diastolic pressure to a level higher than systolic pressure
‒Displaces a volume of blood equal to its inflation volume |
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Term
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Definition
‒Occurs at the end of isovolumetric contraction just before opening of the aortic valve
‒Maintained until the onset of diastole |
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Term
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Definition
‒Correlates with aortic valve closure
‒Should be V shaped |
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Term
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Definition
| Normal peak systolic pressure |
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Term
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Definition
‒Termed diastolic augmentation or peak diastolic pressure (PDP)
‒Produced by balloon inflation upon aortic valve closure at the dicrotic notch
‒Ideally raises diastolic pressure to a level higher than the systolic pressure
‒Mechanically increases optimizing coronary and systemic blood flow |
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Term
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Definition
‒Relates to balloon deflation just before the next systole
‒Should also be U shaped |
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Term
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Definition
–Physiologic signal from the patient to the computer within the IABP console
–Used to indicate the beginning of cardiac cycles and also assesses the length of R-R intervals
•The pneumatic system within the console then appropriately deflates and inflates the balloon in synchrony with the patient’s cardiac cycles |
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Term
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Definition
| Inflation and deflation times in reference to the cardiac cycle |
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Term
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Definition
‒Increased supply
‒Decreased demand |
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Term
| Secondary effects of IABP |
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Definition
‒Increased cardiac output (CO)/ cardiac index (CI)
‒Decreased heart rate
‒Decreased pulmonary capillary wedge pressure (PCWP)/ peripheral arterial disease (PAD)
‒Decreased systemic vascular resistance (SVR)
‒Decreased systolic pressure
‒Decreased end diastolic pressure
‒Increased mean arterial pressure (MAP) |
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Term
| What are the balloons made of on the balloon pump? |
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Definition
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Term
| What are the balloon sizes for the balloon pump? |
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Definition
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Term
| What is the ratios that the IABP is used at? (range) |
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Definition
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Term
| What is the starting ratio for a IABP? |
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Definition
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Term
| What is the second lumen on the IABP used for? |
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Definition
| The second lumen allows delivery of the catheter over a guidewire and subsequent monitoring of central aortic pressure |
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Term
| What size sheath is used for insertion of the IABP |
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Definition
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Term
Assessment after IABP placement
-Routinely check for what? |
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Definition
-Infection
-Thrombocytopenia
-Hemorrhage
-Hemolysis
-Vascular obstruction with limb ischemia |
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Term
| Anticoagulants should be discontinued how long before removal of balloon catheter? |
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Definition
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Term
| How long should pressure be maintained on the puncture site after removing the balloon catheter? |
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Definition
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Term
| What are indications for IABP? |
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Definition
–Cardiogenic Shock
–MI with Mechanical Defects
•LV Failure
•Ventricular Septal Rupture
–Post-op low Output syndromes
–Medical Refractory Angina
•In conjunction with thrombolytic therapy
•Support of high-risk PCI
•Wean from cardiopulmonary bypass
•Ventricular assistance of stunned myocardium
•Drug induced Failure
•High risk percutaneous transluminal coronary angioplasty (PTCA)
•Patients with left main coronary stenosis or severe three-vessel disease undergoing anesthesia for cardiac surgery
•Assist to CPR |
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Term
| Contraindications for IABP? |
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Definition
•Irreversible brain damage
•Not recommended for patients with chronic end-stage heart disease who are not awaiting cardiac transplantation
•Aortic valve insufficiency
•Aortic dissection
•Aortic aneurysm
•Severe peripheral vascular disease (e.g., absent femoral pulse)
•Moderate or severe aortic regurgitation
•Bleeding diathesis
•Sepsis
•Coagulopathy |
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Term
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Definition
-Local or systemic infection
-limb ischemia (most common complication, due to arterial or catheter thrombus)
-bleeding
•Thrombocytopenia
–Damage or reduction in number of platelets
•Aortic Dissection
•Compartment Syndrome
•Balloon Leak
–Could be due to defective device, however, also due to calcified plaque on the aorta
•May cause clot inside balloon or gaseous embolic injury
-Migration of Catheter
–Important to notice absent left radial pulse, or decreased -> no urine output
•Atelectasis
–2 strict bed rest
•Death |
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Term
| MVO2 is affected by what? |
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Definition
–Increased heart rate (HR) increases demand
–Increased afterload increases demand
–Increased preload increases wall tension
–Increased contractility increases demand |
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Term
| Myocardial oxygen supply controlled by what? |
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Definition
–Coronary anatomy
–Diastolic pressure
–Diastolic time
–Oxygen extraction |
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Term
| Stroke volume determining factors |
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Definition
‒Preload
‒Afterload
‒Contractility
‒Heart rate |
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Term
| What is the balloon inflation termed as? |
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Definition
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Term
| If the balloon catheter remains immobile for more than 30 minutes what can this cause? |
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Definition
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Term
| What does inflation of the balloon catheter during diastole do? |
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Definition
Increased Myocardial Oxygen Supply
•Increasing blood flow to the coronary arteries
•Increasing renal artery perfusion |
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Term
| What does deflation of the balloon catheter just before systole do? |
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Definition
Decreases Left Ventricle Afterload
-decreases cardiac work
-decreases MVO2
-increases cardiac output |
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Term
| What is used to fill the balloon on the balloon pump catheter? |
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Definition
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Term
Direct effects of IABP therapy
-Diastole / Inflation |
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Definition
–↑ aortic diastolic pressure
–↑ coronary perfusion
–↑ O2 supply
–↑ aortic root pressure |
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Term
Direct effects of IABP therapy
-Systole / Deflation |
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Definition
–↓ aortic end-diastolic pressure
–↓ afterload
–↓ O2 consumption
–↓ impedance to ejection, ↑ cardiac output (by about 20-30% |
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Term
| What are the secondary hemodynamic effects of IABP? |
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Definition
–↑ CO / CI
–↑ MAP
–↓ HR
–↓ PCWP / PA diastolic
–↓ SVR
–↓ Systolic Pressure
–↓ End Diastolic Pressure |
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Term
| If bleeding is noted at the site of insertion what should you do? |
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Definition
| "stop the bleed" digital pressure |
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Term
| Two principle modes of triggering inflation and deflation |
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Definition
•Arterial pressure waveform
•ECG |
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Term
| What is the waveform timing? (inflates and deflates when?) |
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Definition
–Balloon inflation on the dicrotic notch (DN)
–Deflation is just prior to the next systole |
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Term
| What are the timing errors? |
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Definition
•Early inflation error
•Late inflation error
•Early deflation error
•Late deflation error |
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Term
| What is potentially the most critical timing error? |
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Definition
Late deflation error
•Can result in acute hypotension and cardiac arrest
•The LV must eject against the resistance imposed by the inflated balloon |
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Term
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Definition
‒Decreased resistance to opening the aortic valve and left ventricular ejection (decreased afterload)
‒Decreased myocardial work and oxygen consumption
‒Increased stroke volume and cardiac output
‒Decreased left ventricular preload |
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