A summary about how to use & interpret IABCP To download send me an email to sherif_badrawy@yahoo.com

1. Intra-aortic balloon
counterpulsation (IABCP)
DR. SHERIF BADRAWY

2. IABP has two parts ?
1a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy
Digitally signed
by Dr.Sherif
Badrawy
Date: 2015.11.11
16:26:25 +03'00'

3. ☆ catheter with a long sausage-
shaped balloon at the distal tip
☆ a pump that inflates the
balloon
1b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

4. balloon volumes
2a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

5. about 30-50 mL
filled with helium
when inflated fill 80-90% of the
aorta
2b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

6. Function of IABCP ?
3a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

7. ☆ Balloon inflation during diastole
augments DBP ➜ displaces blood
proximally and distally ➜ ⇧systemic
and coronary perfusion
☆ balloon deflation decreases
afterload during systole ➜
⇩myocardial oxygen demand
3b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

8. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

9. Balloon inflation in early
diastole usually triggered by ?
4a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

10. the R wave on the ECG
4b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

11. Pt developed AF, how IABCP will
be triggered ?
5a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

12. ☆ IABP cannot be successfully triggered using
the R waves in AF.
☆ pacing spikes or the arterial blood
pressure waveform may used for triggering
☆ pump can be set at an intrinsic rate
without any physiological triggering.
☆ the patient remains HD stable despite the
IABP malfunctioning ➜ REMOVE IT.
5b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

13. IABCP Used in ?
6a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

14. pump failure if may resolve
spontaneously, or
a corrective procedure is
planned.
6b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

15. indications for IABP ?
7a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

16. ☆ Cardiogenic shock, after CABG, acute MI.
☆ Acute MR
☆ Planned cardiac transplant
☆ V arrhythmias refractory toRx
☆ cardiotoxicity from poisoning, e.g.
verapamil
7b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

17. Insertion technique for IABP ?
8a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

18. ☆ Seldinger technique
☆ Fluoroscopy is not essential
☆ femoral artery
☆ proximal descending aorta.
☆ tip just distal to the origin of the left
subclavian artery
☆ entire balloon lie above the renal AA
☆ position should be checked on CXR
☆ if D/C sheath must be removed first
8b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

19. Contra-indications for IABP ?
9a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

20. ☆ AR, Aortic dissection
☆ PDA
☆ Severe peripheral vascular disease
☆ Thoracic aortic graft <12 months old ☆
cardiac index is too low for there to be a
clinical benefit from IABP assistance
9b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

21. IABP efficiency is determined by
10a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

22. ☆ Timing of balloon inflation and deflation Assist
ratio (1:1 - balloon inflation & deflation with
cardiac cycle ➜ > circulatory assistance than 1:2 or
1:4 - balloon inflation and deflation on every 2nd
or 4th cardiac cycle )
☆ Heart rate (⇩efficiency at HR >130/min)
☆ balloon volume
☆ Minimum CI of 1.2 - 1.4 L/min/m2 required for
IABP to be clinically beneficial.
10b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

23. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

24. Optimisation of IABPs?
11a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

25. ☆ inflation at the dicrotic notch (forming the sharp 'V')
☆ the slope of rise of augmented diastolic waveform is
straight and parallel to the systolic upstroke
☆ the augmented DBP at balloon deflation exceeds or is
equal to end-systolic BP
☆ the end-diastolic BP at balloon deflation is lower than
the preceding unassisted end-DBP by 15- 2 mmHg
☆ the assisted SBP (following a cycle of balloon inflation) is
lower than the previous unassisted SBP by 5 mmHg
11b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

26. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

27. complications of IABPs?
12a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

28. ☆ failure to insert
☆ aortic dissection and arterial perforation ➜
retroperitoneal Hge
☆ LL Ischemia
☆ Catheter-related
☆ Balloon rupture ➜ helium embolus (key indicator of
balloon rupture is blood in the connecting tubing)
☆ Hemolysis and consumptive thrombocytopenia
☆ Peripheral neuropathy
12b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

29. IABP weaning & removal:
13a
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

30. • Decrease inotropic support
• Decrease IABP ratio
• Discontinue heparin(+ platelet transfusion?)
• Deflate balloon
• Remove balloon while alternating pressure
above and below insertion site to expel clots
• Apply constant pressure to insertion site at
least 30 min
13b
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

31. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

32. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

33. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

34. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

35. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

36. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

37. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

38. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

39. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

40. IABCP Troubleshooting
Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

41. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

42. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

43. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

44. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

45. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

46. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

47. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy

48. Intraaortic Baloon Counter Pulsation
Dr.Sherif Badrawy