Intra-aortic balloon pump

The intra-aortic balloon pump (IABP ) is an emergency medical aid to support a failing heart activity (eg after myocardial infarction) with the aim of avoiding a cardiogenic Schockes. It is needed for the implementation of intra-aortic balloon. Their use is indicated when other measures, such as medications and ventilation are not sufficient.

  • 3.1 indications
  • 3.2 Contraindications
  • 3.3 complications

History

The concept of intra-aortic balloon was developed in 1962 by the SD Moulopoulos cardiologist. First uses of intra-aortic balloon made ​​at the end of the 60s by Adrian Kantrowitz in patients in cardiogenic shock. Later, there was a growing automation of the necessary devices ( intra-aortic balloon pump = IABP ), as well as to significant advances in the field of intaaortalen balloon catheter ( IAB ). The procedure was always known by numerous publications. Nowadays, the IABP therapy is a relatively simple, rapidly deployable and compared to other systems Assist relatively low complication support method dar.

Basics

Principle

The IABP is needed to perform the intra-aortic balloon. It is placed (eg via the femoral artery using Seldinger technique ) into the descending aorta just below the waste stream of the left subclavian artery and above the waste stream of the renal arteries. The corresponding catheter is connected to the IABP. A subsequent position control ( X-ray marker at the proximal and distal end of the balloon allow this through a chest x-ray ) is mandatory.

The balloon inflates immediately after closing of the aortic valve with about 30-40 cm3 helium, thereby preventing the diastolic blood flow towards the lower half of the body. In the upper half of the body thereby, however, increased the diastolic flow. Immediately before the beginning of systole, the balloon deflated active (" empty eyes " ) again, thereby enabling the flow of blood towards the lower half of the body freely. The unit is customized, with filling and emptying are not always carried out at each heart beat.

In order not to miss the optimum time points for the inflation of the balloon and aspiration, it requires a trigger. When filling serve a pressure measurement directly over the IABP ( characteristic change of arterial pressure at Aortenklappenschluss ) or a time point determination based on the pressure profile in a radial wrist artery or a leg artery. During active emptying the time of the lowest diastolic pressure is best detected by measuring directly from the IABP.

Effect

The main effect of intra-aortic balloon is to increase the myocardial oxygen supply and decrease myocardial oxygen consumption:

  • The inflation of the IABP in diastole increases the blood flow in the upper half of the body and improves the blood supply to the brain and heart (diastolic pressure in the aorta and ↑ ↑ Koronarperfusionsdruck )
  • The active deflation of the IABP reduces the end-diastolic aortic pressure, thereby reducing the workload of the left ventricle (duration of the isovolumetric contraction of the left ventricle ↓, end-systolic pressure in the left ventricle and left ventricular afterload ↓ ↓).

In summary, by an increase in myocardial oxygen supply ( coronary perfusion ) and a reduction of myocardial oxygen demand by Nachlastverringerung is effected, and the cardiac output increases by up to 40%.

Caused by the increase in cardiac volumes, lowering the oxygen demand of the heart and the improvement of coronary and cerebral perfusion of the affected patient may, in appropriate cases, at least temporarily stabilized ( alive ) are.

Application

Basically, the IABP is displayed with impending or overt cardiogenic shock when other measures such as medication or artificial respiration are insufficient in patients. However, conditions for this are still measurable existing blood pressure, a regular heart rhythm and not too far advanced heart failure ( cardiac index at least 1.5 l/Minute/m2 ):

Indications

Contraindications

As an absolute contraindications:

As a relative contraindications:

Complications

As a classic complications Arterial occlusive disease which makes the targeted insertion of the balloon impossible, and a piercing ( perforation ) of iliac artery or aorta apply. At too far distally placing or slipping of the balloon catheter may cause a transfer of the renal arteries and thus kidney failure.

Mechanical ventilation Aortic arch Radial artery Renal failure
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