Overview of Intra-Aortic Balloon Pump
When your heart is not pumping enough blood to your body (a condition that doctors call ‘hypoperfusion’), it can be a serious problem and can be caused by heart failure or a heart attack (also known as cardiac arrest). This condition is very serious and can sometimes result in death quite quickly.
To help manage this condition and improve chances of survival, special medical devices have been developed to increase the blood flow in your body. These devices, called mechanical circulatory support devices, can help until the underlying issue causing the heart problems can be addressed. Currently, there are four main types of these devices:
1. Intra-aortic balloon pump (IABP)
2. Non-IABP ventricular circulatory assist devices
3. Extracorporeal membrane oxygenation devices
4. Non-percutaneous ventricular assist devices
Among these, the Intra-aortic balloon pump (IABP) device stands out as the simplest and most cost-effective option. It can be easily placed and removed by a heart specialist in a lab. Additionally, it can be effectively managed by an intensivist (a specialist who takes care of seriously ill patients) in an intensive care unit.
While the IABP may not have as dramatic an effect as some of the newer, more advanced devices, it is generally safer to use and has beneficial impacts on the heart and circulation. This makes it a popular choice for patients who need help with their blood circulation during heart failure or those at risk of destabilization during a high-risk heart procedure.
However, as with any medical treatment, the evidence supporting the use of IABP is continuously changing. It’s crucial for doctors and patients to stay updated on the latest research and safety information about this device. Ultimately, the decision to use an IABP will be based on a thorough review of the condition and risks for each patient.
Anatomy and Physiology of Intra-Aortic Balloon Pump
The Intra-Aortic Balloon Pump (IABP) is a device that helps the heart work more efficiently. It reduces the workload of the heart and also helps improve blood flow to the body’s organs and tissues. This balloon pump inflates during a specific stage of the heart’s cycle, called diastole (when the heart is resting), helping to push blood into the body from the main artery (aorta). Then it quickly deflates before the heart’s next contraction (systole), lowering the pressure the heart needs to pump against. This deflating helps the heart’s main pumping chamber, the left ventricle, to not have to work as hard, lowering its need for oxygen. This, in turn, can improve the heart’s strength and efficiency, especially in patients with weakened heart function.
A study showed that using the IABP could increase the flexibility of the aorta by 30%, significantly reduce the heart’s oxygen needs by 31%, and increase the pumping efficiency of the heart by 24%. Using this device can be particularly beneficial for those individuals suffering from a weak heart, as it can enable the heart to pump out more volume of blood per heartbeat.
Several other studies suggested that the IABP might also help patients suffering from acute right heart failure. The device does this by reducing the pressure in the blood vessels of the lungs and the heart’s main pumping chamber, thereby improving the overall output of the heart.
However, studies on the impact of the IABP on blood flow to the heart itself have provided mixed results. Some evidence showed that the IABP enhances blood flow to the heart muscles, particularly in patients with unstable heart conditions, while in others, no significant increase in blood flow was noted. But overall, the IABP seems to more reliably reduce the oxygen needs of the heart than significantly improve blood flow to the heart muscles.
Interestingly, another study showed that the IABP could positively affect blood flow to the brain in patients suffering from acute heart failure. This increased blood flow was more noticeable in those patients with severely weakened heart function. There is a need for further study to understand better how improving blood flow to the brain in heart failure patients might help improve their conditions.
Why do People Need Intra-Aortic Balloon Pump
There are several specific circumstances where a medical device may need to be placed in a patient’s body. These include:
1. If someone is experiencing a severe episode of congestive heart failure accompanied by low blood pressure. Congestive heart failure is a condition where the heart is not able to pump blood effectively, causing the body to not receive enough oxygen and nutrients.
2. The device may be used as a preventative measure or additional treatment during a high-risk heart procedure. This can help improve the patient’s heart function and increase their chances of a successful operation.
3. Someone who has suffered a heart attack and this has caused the left side of their heart to not pump blood effectively, leading to low blood pressure.
4. If a patient has had a heart attack and a mechanical problem has occurred as a result, causing the heart to not be able to pump blood effectively. This can include sudden severe leakage of the mitral valve due to the tearing of the muscles that control it, or a rupture in the wall that separates the heart’s lower chambers.
5. When a patient has low heart function following surgery to redirect blood around clogged arteries in the heart.
6. The device can also act as a temporary solution for treating patients with certain severe heart conditions, until a definitive treatment can be provided. These conditions could include persistent chest pain or heart damage due to poor blood flow, unmanageable heart failure, or uncontrollable heart rhythm problems.
When a Person Should Avoid Intra-Aortic Balloon Pump
There are certain situations when the use of an intra-aortic balloon pump is not recommended. These include:
Uncontrolled sepsis, a dangerous condition where the body’s response to an infection is damaging its own tissues.
Uncontrolled bleeding diathesis, a condition in which the body cannot stop bleeding. This could pose significant risk during any surgical procedure.
Moderate to severe aortic regurgitation, a condition where the heart’s aortic valve doesn’t close tightly and allows some of the blood that was just pumped out of the heart to leak back into it.
If a patient has an aortic aneurysm or aortic dissection. This means that either there is a bulge, or ballooning, in a part of the aorta, the main artery of the body, or there is a serious condition where the inner layer of this artery has torn.
Severe peripheral artery disease where blood vessels in the body are narrow. This is especially the case when it hasn’t been treated with a procedure to widen the blood vessels, called stenting.
Equipment used for Intra-Aortic Balloon Pump
When your doctor needs to insert a device called the intra-aortic balloon pump (a tool used to help your heart by inflating or deflating to help blood flow), they will use a specific set of tools and equipment. Here’s a simplified version of what they might need:
A kit specifically for the intra-aortic balloon pump: This includes the pump itself and an IABP catheter which is a thin, flexible tube. The kit also has an arterial dilator (a device to help enlarge the artery), a guidewire (a tool to help place the catheter), and an angiographic needle.
Your doctor will need a surgical mask, sterile gloves and a gown to protect both themselves and you from infection. They will also use sterile drapes – sheets that create a clean work environment over your body during the procedure.
For your comfort, they will use a 1% lidocaine solution, a type of local anesthetic used to numb the area. They will also use a special clean solution that may contain povidone-iodine or hexachlorophene on chlorhexidine with alcohol to sterilize the skin.
Other tools include a 25-gauge needle, a 5 cc syringe, a handle for a scalpel with a blade, and sterile saline (a saltwater solution) and lubricant. They will also need sterile transparent tape and dressing (bandages), a tissue clamp (to hold tissue in place), a 2-0 silk suture (a type of stitch), a safety razor (to shave the area, if needed), a 0.035 J guidewire and a fluoroscopy device (an imaging technique that takes real-time moving images of the inside of the body).
Before they insert the intra-aortic balloon pump, it’s important that they get your consent, meaning you understand and agree to the procedure. This involves your doctor carefully explaining to you the risks and benefits of the procedure.
Who is needed to perform Intra-Aortic Balloon Pump?
If you need a device called an intra-aortic balloon pump, you’ll be taken care of in an Intensive Care Unit (ICU), a special part of the hospital where they can watch you very closely. Here, nurses and doctors will keep a constant eye on your heart and the amount of oxygen in your blood using special monitors.
Only medical professionals trained in placing and managing the balloon pump are allowed to do so. They are experts at spotting any problems early so they can fix them right away using established guidelines.
These professionals work together as a team to make sure you get the best care possible. This team might consist of a heart doctor (Interventional cardiologist), a specialist in looking after very sick patients (Intensivist), nurses trained in looking after patients in the ICU or heart patients in particular, and a team of heart surgeons. The type of team depends on whether your heart problems need surgery or not.
Preparing for Intra-Aortic Balloon Pump
Before a procedure called an Intra-Aortic Balloon Pump (IABP) insertion, it’s essential for the doctor to explain clearly what the procedure involves and what its potential risks and benefits are. The patient needs to understand this well and agree to the procedure, which is often referred to as giving ‘informed consent’. Furthermore, patients need to follow certain aftercare instructions. For instance, if the IABP was inserted via the femoral artery (an artery in the leg), the patient mustn’t bend that leg and will not be able to walk until the device has been put in its correct place.
Before the doctor can go ahead with the procedure, the patient’s overall health must be painstakingly reviewed. The doctor should be vigilant for any abnormalities that could cause bleeding, any ongoing infection, and the severity of any pre-existing peripheral arterial disease (a condition where the blood vessels outside your heart get narrow).
The patient will lie flat on their back during the procedure, which allows for easier access to the necessary areas. Also, maintaining a sterile environment is crucial throughout the procedure to avoid any infection. This means that everything – the doctor, nurses, surgical instruments, and the surroundings – needs to be clean and germ-free.
How is Intra-Aortic Balloon Pump performed
The doctor begins your procedure by making sure your upper leg is clean to avoid possible infections. They will then numb the area. After that, they insert a special needle into a large artery (the common femoral artery) found in your leg, just beneath the crease in your hip. A machine, called a fluoroscope, gives the doctor a view of the inside of your leg to ensure that they’re placing the needle correctly. This is vital because placing the needle incorrectly might lead to serious complications like bleeding in the abdomen or problems with leg circulation.
Once the needle is in the right spot, a wire with a curved tip, called a guidewire, is threaded through the needle into the artery. The needle is then removed, but the guidewire is left inside. A small cut in the skin is made around the guidewire to ease the insertion of the next tool – a sheath introducer.
This sheath introducer is a tube that helps make way in the artery for another device, the intra-aortic balloon pump (IABP) catheter. To get the sheath introducer into the artery, a special dilator is threaded over the guidewire and then twisted into the artery.
Once the dilator is in place, the sheath introducer is slid over the guidewire and into the artery. Then, the guidewire is taken out, leaving the sheath introducer in place inside your artery. Another, thinner guidewire is inserted through the sheath and into your body all the way up to the heart.
The IABP catheter (tube) is then prepared to enter your body. To do this, they will suck out any air and add sterile liquid to it to make sure it works properly. The tube is then carefully threaded over the thin guidewire and pushed through the sheath introducer. It is carefully positioned within the main artery (the aorta) in your body. The ideal position is just below your left shoulder’s artery (left subclavian artery) and just above the arteries that supply your kidneys with blood.
The doctor checks the position using an x-ray or the fluoroscope. Once it’s in the correct place, they can remove the guidewire. The doctor will then flush out the tube and connect it to a device to monitor the pressure inside your aorta. The tube is also connected to the actual balloon pump machine via an extender tube.
Possible Complications of Intra-Aortic Balloon Pump
The Benchmark Registry maintains records of complications related to a heart procedure known as Intra-aortic Balloon Pump insertion (IABP). This registry shows that serious issues, such as severe bleeding, major issues with a limb, balloon leaks or death related to the procedure itself, have happened in 2.6% of cases. Moreover, 21.2% of patients passed away while in the hospital, but only 0.05% of those deaths were directly tied to the procedure.
In a detailed look at more than 5000 patients who received the IABP after a heart attack, the registry noted the following:
– All complications amounted to 8.1% of cases.
– Major complications occurred in approximately 2.7% of cases, while minor complications were noted in 5.4% of cases.
– Bleeding complications at the site of insertion happened in 4.3% of cases, with severe bleeding in 1.4% cases, and blood transfusion was needed in 1.4% of cases.
– Various issues with the limbs and vascular system (the body’s network of blood vessels) were also noted:
– Any issue with the limbs: 2.3%
– Major limb issues, which might mean a lost pulse, loss of sensation in a limb, or potentially needing surgical repair or amputation: 0.5%
– Needing vascular surgery: 0.7%
– Issues like infection and stroke each occurred in about 0.1% of cases.
– Issues directly related to the balloon pump, such as leaks, poor inflation, and difficulty with insertion, were also reported.
Certain factors were found to increase the risk of major issues. These include: being a woman, having peripheral vascular disease (a condition that causes poor blood circulation), being 75 or older, and having a body surface area less than 1.65 m. Other factors like the length of time needing the balloon pump, the size of the catheter, diabetes, and a low cardiac index (which measures how well the heart is performing) also played a role.
Additional studies, like the IABP SHOCK II Trial, compared the outcomes between patients treated with an IABP vs those who did not receive one. The study found no significant difference between the two groups in terms of serious bleeding, peripheral ischemia (poor blood supply causing damage), sepsis (a life-threatening reaction to infection), and stroke risks.
What Else Should I Know About Intra-Aortic Balloon Pump?
An intra-aortic balloon pump (IABP) is a type of device that helps the heart pump blood, especially in people suffering from a severe heart attack. This device can provide temporary help to the heart when it’s unable to maintain stable blood flow with medication alone. This intervention is apt for patients with a severe form of heart attack stratified under acute myocardial infarction.
However, the decision to use an IABP should take into account several factors including the age of the patient, overall health status, brain function, long-term survival chances and the quality of life expectations. It’s especially recommended for patients who have severe heart complications, including heart failure – but even then, it should be used only as an immediate solution, followed up by immediate treatment of the heart problem.
Procedural success rates and choice of treatment can significantly impact the outcome for patients suffering from acute heart failure associated with a heart attack. Studies have repeatedly shown that procedures to clear up blocked arteries, like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG), can substantially improve patient survival rates when done in a timely fashion.
However, some research suggests that using an IABP as an additional measure to treat severe heart attacks does not always make a significant difference in patient outcomes. For instance, one study found that the addition of IABP did not significantly improve the mortality rate at 30 days after the event compared to standard medical treatment alone.
The role of the IABP in treating patients after a severe heart attack remains contested by the medical community. However, it’s important to remember that deciding the best treatment option for a patient is highly dependent on their individual condition and overall health. Hence, while this device might not always be necessary, according to some studies, they are still routinely used in cardiac care units due to their potential benefits in certain cases.
The use of the IABP has been on the decline, probably due to the increased rates of positive outcomes connected with PCI procedures and improvements in heart attack treatment guidelines. Nevertheless, for patients who are in shock after a severe heart attack, the American Heart Association and the American College of Cardiology do recommend the use of an IABP – especially for those who are not responding well to pharmacologic treatment.
