Intraaortic balloon counterpulsation/secondary school (nurse)

• A method of temporary mechanical support of hemodynamics, designed primarily for the treatment of cardiogenic shock in cases where catecholamine therapy fails.
• In balloon counterpulsation (IABP), there is a regular, heart-cycle-synchronized expansion and emptying of a long balloon with helium, which is located in the upper region of the descending aorta:

→ in diastole, the balloon is inflated → an increase in blood pressure in front of the balloon, an increase in the flow věnčitými tepnami;

→ at the beginning of systole, the balloon is emptied → a decrease in outflow resistance → an increase in the flow through the aorta.

Effect of IABP

• Reduction of cardiac load;
• increasing the supply of nutrients to the heart muscle;
• reducing myocardial oxygen consumption (by increasing the minute volume, slowing the heart rate).

Indication

• Cardiogenic shock;
• acute coronary syndrome unresponsive to standard therapy;
• low cardiac output syndrome;
• cardiac surgical operations;
• support in ECMO;
• septic or anaphylactic shock − circulatory support:

→ important early start, before the complete collapse of circulation.

• „Preventive“ introduction before cardiac surgery in extremely high-risk patients or before major surgery of another type in cardiac patients in advanced heart disease.

Contraindications

• Thrombolytic therapy;
• septic state;
• atherosclerosis obliterans;
• aortic regurgitation;
• trauma of the aorta;;
• aortic aneurysm.

Complications

• Ischemia of the lower extremities (thromboembolism);
• the emergence of infection;
• aortic rupture;
• thrombocytopenia;
• technical – balloon rupture, gas leakage, device failure.

Prevention

• IABP only the necessary time;
• inspection of the lower extremities;
• bandage of the injection site after removal of the cannula.

Links

References

• KOLÁŘ, Jiří. Cardiology for intensive care nurses. 4. edition. c2009. ISBN 9788072626045.

• MANĎÁK, J. – LONSKÝ, V. – ŽÁČEK, P.. Intraaortic balloon counterpulsation. [online]. ©2005. [cit. 2012-01-31]. <www.kardiologickeforum.cz>.