Makindo Medical Notes

Related Subjects: Atropine |Acute Anaphylaxis |Basic Life Support |Advanced Life Support |Adrenaline (Epinephrine) |Acute Hypotension |Cardiogenic shock |Distributive Shock |Hypovolaemic or Haemorrhagic Shock |Obstructive Shock |Septic Shock and Sepsis |Shock (General Assessment) |Toxic Shock Syndrome

The intra-aortic balloon pump (IABP) is a mechanical circulatory support device designed to improve coronary and cerebral blood flow by augmenting diastolic aortic pressure. It is often used as a bridging measure to more definitive therapies or in acute settings to stabilize hemodynamics.

About

• The IABP enhances coronary and cerebral perfusion by inflating during diastole to increase aortic pressure and deflating during systole to reduce afterload.

Method

• A balloon catheter (35–50 ml capacity) is introduced via the femoral artery and positioned in the descending aorta, just distal to the left subclavian artery.
• Helium is used to rapidly inflate and deflate the balloon in synchronization with the cardiac cycle—typically inflating during diastole and deflating before systole.
• This timing optimizes diastolic pressure to improve coronary perfusion and reduces afterload, thereby decreasing myocardial oxygen demand.

Indications

• Bridge to Transplant: In patients with end-stage heart failure awaiting a heart transplant.
• Cardiogenic Shock / Acute Left Ventricular Failure: To stabilize hemodynamics and improve end-organ perfusion.
• Refractory Unstable Angina: As an adjunct measure when medical therapy is insufficient to relieve ischemia.

Contraindications

• Aortic Valve Disease: Aortic regurgitation or large aortic aneurysms, where increasing aortic pressure could exacerbate the condition.
• Severe Peripheral Vascular Disease: Significant aorto-iliac disease may prevent safe catheter insertion and positioning.

Complications

• Aortic Dissection: The balloon can create or worsen a dissection if the aortic wall is weakened.
• Lower Limb Ischemia: Femoral artery cannulation can compromise distal blood flow, particularly in vessels with atherosclerotic disease.