Makindo Medical Notes

🫀 The intra-aortic balloon pump (IABP) is a mechanical circulatory support device used in critical care to augment diastolic aortic pressure, thereby improving coronary and cerebral blood flow. ⚡ It serves as a bridge to recovery or definitive therapy (e.g., PCI, transplant, LVAD) in unstable patients.

ℹ️ About

• The IABP works by inflating during diastole to increase aortic pressure (improving coronary perfusion) and deflating just before systole to reduce afterload and myocardial oxygen demand.
• Overall effect: ↑ myocardial oxygen supply, ↓ myocardial oxygen consumption.
• Best results are in patients with some residual LV function—ineffective in profound cardiac standstill.

🛠️ Method

• A balloon catheter (usually 35–50 ml) is inserted via the femoral artery and positioned in the descending thoracic aorta, just distal to the left subclavian artery.
• Helium is used for rapid inflation/deflation due to its low density and rapid diffusibility.
• Inflation occurs at the dicrotic notch on the arterial waveform (early diastole), and deflation just before systole (end-diastole).
• Synchronization is guided by ECG or arterial pressure waveform.

📋 Indications

• 🔄 Bridge to Transplant / LVAD: Advanced heart failure patients awaiting definitive therapy.
• 💔 Cardiogenic Shock: Particularly post-MI to stabilize perfusion.
• 🔥 Refractory Unstable Angina: When ischemia persists despite maximal medical therapy.
• 🩺 Mechanical Complications of MI: e.g., papillary muscle rupture, VSD (as a bridge to surgery).

⛔ Contraindications

• 🚫 Aortic Regurgitation: Worsens regurgitant flow as diastolic pressure is increased.
• 🚫 Aortic Dissection / Aneurysm: Can propagate dissection or rupture aneurysm.
• 🚫 Severe Peripheral Vascular Disease: Cannulation may be technically impossible or cause severe ischemia.

⚠️ Complications

• 🩸 Vascular Injury: Limb ischemia, femoral artery occlusion, haematoma.
• 🫀 Aortic Dissection / Rupture: Rare but catastrophic complication.
• 🧠 Stroke / Embolism: Due to dislodgement of aortic plaques or thrombus formation.
• 🦠 Infection: At insertion site or catheter-related sepsis.
• 🔌 Device Failure: Malposition or rupture of balloon.

📚 Exam Tip: IABP inflates in diastole (improves coronary perfusion) and deflates just before systole (reduces afterload). 💡 If you see a patient in cardiogenic shock post-MI with poor perfusion → think of IABP as a bridge until revascularization or transplant.