IABP

Intra aortic balloon

counter pulsation( IABP):
 Indications for IABP
• Cardiogenic shock
• In association with CABG
• In association with PPCI
• Stabilization of cardiac transplant recipient
• Post myocardial infarction
• Ventricular arrhythmias related to ischemia
console
 Positioning of baloon in IABP
• Proximal end Just below (1-2cm) the left
subclavian artery in the aorta and and distal
end above renal artery
 Inflation &deflation
• Inflation-diastole

• Deflation-just at the onset of systole

ECG signal – most common
• Inflation
- middle of T wave
• Deflation
– peak of R wave•

Arterial waveform
inflation- dicrotic notch
deflation-just before the next
systolic upstroke
advantages
 Contraindications to IABP

Severe aortic valve insufficiency

 Aortic aneurysm
 Aortic dissection
 Limb ischemia
 Thrombo embolism
 Patient Management During IABP support

Anticoagulation-- maintain APTT at 50 to 70 seconds

CXR daily – to R/O baloon migration

Check lower limb pulses - 2 hourly.

- If not palpable » ?- vascular obstruction
- thrombus, embolus, or
dissection (urgent surgical consultation)

Prophylactic antibiotics

Hip flexion is restricted, and the head of the bed should

not be elevated beyond 30°.
Never leave in standby by mode for more than 20 minutes –leads
to thrombus formation

Daily assess
• – Haemoglobin (risk of bleeding or haemolysis)
• – Platelet count (risk of thrombocytopenia)
• – Renal function (risk of acute kidney injury secondary to distal
• migration of IABP baloon and obstruction of renal artery)

Wean off the IABP as early as possible, as longer duration is

associated with higher incidence of limb complications
 Weaning of IABP
• Timing of weaning:

• - Patient should be stable for 12 – 24 hours

• - Decrease inotropic support
• - Decrease pump ratio
• – From 1:1 to 1:2 or 1:3
• - Decrease augmentation
• - Monitor patient closely

• – If patient becomes unstable, weaning should be

immediately discontinued
 IABP Removal

- Discontinue heparin 1 hour prior to removal

- Disconnect the IABP catheter from the IAB

pump

• - Patient blood pressure will collapse the

balloon membrane for withdrawal
• Withdraw the IAB catheter through the introducer sheath until resistance is
met.

- NEVER attempt to withdraw the balloon membrane through

- the introducer sheath.

- Remove the IAB catheter and the introducer sheath as a unit

- Apply pressure just distal to the puncture site before removal

of the IAB catheter and allow the blood to escape for 2-3

heart beats after cathter removal,(to allow blood clots to escape and

prevent embolism of the leg) and then apply pressure above the puncture site
to stop bleeding

• - Check for adequacy of limb perfusion after hemostasis is achieved.

ASSESSMENT AND MONITORING
Pedal pulses assessment
Circulation assessment 2hourly
Insertion site assessment
Bleeding and
signs of
infection

Dressing change
as needed
 Monitor APTT value

• 4th hourly
•Maintained APTT at 50-70seconds
•Heparin bolus dose given as per
APTT value
Monitor urine output
Calf circumference measurement

• Compartment syndrome
Thank you