Intra- Aortic Balloon Pump (IABP)

SPONSORED ADVERTISEMENT

ANAESTHETIC PRACTICE MANAGEMENT

Designed for Anaesthetists by Anaesthetist

Nova streamlines your anaesthetic practice with expert management, billing and financial services – so you can focus on what truly matters.

Learn More
View Notes

{}

Principle of IABP

Pasted%20image%2020240301125332.png

  • Intra-aortic balloon counter-pulsation is an invasive method of hemodynamic support:
    • A catheter with a balloon is placed via an arterial sheath and advanced into the descending thoracic aorta.
    • The balloon inflates in diastole → ↑ coronary perfusion.
    • The balloon deflates in systole → ↓ afterload, ↓ LV stroke work, ↑ cardiac output.
    • The thick-walled LV benefits from ↓ afterload and ↑ coronary perfusion during diastole.

Concept

  1. Diastolic Pressure Time Index (DPTI):

    • A measure of coronary perfusion.
    • Calculated as: Coronary perfusion x Diastolic time.

  2. Systolic Tension Time Index (STTI):

    • Represents oxygen demand.
    • Calculated as: Systolic pressure x Systolic time.
  • Effect of IABP:
    • Increases DPTI (improving coronary perfusion).
    • Reduces STTI (decreasing myocardial oxygen demand).

Pasted%20image%2020240520225035.png

  • Top trace = aortic pressure
  • Bottom trace = ventricular pressure

Uses

  • Cardiogenic shock
  • Bridge to intervention/transplant
  • Interfacility transfer
  • LV vent in patients on VA ECMO
  • Meta-analyses show no overall survival benefit, but selected patients (e.g., cardiogenic shock) may benefit.

Placement

  • Positioned in descending thoracic aorta, with the tip 2 cm distal to the left subclavian artery.

Haemodynamic Effects

Aorta

  • ↓ SBP
  • ↑ DBP

Left Ventricle

  • ↓ Systolic pressure
  • ↓ End-diastolic pressure
  • ↓ LV volume and wall tension

Heart

  • ↓ Afterload
  • ↓ Preload
  • ↑ Cardiac output

Coronary Flow

  • ↑ or preserved coronary perfusion

Indications

  • Acute MI with mechanical/valvular complications
  • Cardiogenic shock
  • Unstable angina
  • High-risk PCI
  • Weaning from cardiopulmonary bypass
  • Bridge to cardiac transplant
  • Adjunct in cardiac surgery

Pasted%20image%2020240701173314.png

View or edit this diagram in Whimsical.

Contraindications (CI)

Absolute

  • Aortic regurgitation
  • Aortic dissection
  • Aortic stents
  • End-stage cardiac disease
  • Patient refusal

Relative

  • Abdominal aortic aneurysm (AAA)
  • Severe peripheral vascular disease (PVD)
  • Tachyarrhythmias
  • Major arterial reconstruction

Triggering Mechanisms

ECG Triggering

  • Preferred method.
  • Inflation: Mid-T wave
  • Deflation: Peak of R wave
  • Susceptible to interference from pacing or arrhythmias.

Pressure Triggering

  • Alternative option.
  • Based on dicrotic notch (aortic valve closure).
  • Less accurate due to slower propagation of pressure waves compared to electrical conduction.

Timing

Optimal Timing:

  • Inflation: ~40 ms after dicrotic notch (start of diastole).
  • Deflation: Just before systole.

Improper Timing Consequences:

  • Early inflation → ↑ afterload
  • Late inflation → ↓ diastolic augmentation
  • Early deflation → ↓ O₂ demand benefit
  • Late deflation → ↑ afterload
  • Poor timing → ↓ perfusion

Target ratio: 1:2 mode for initial assessment

Augmentation & Weaning

  • Default mode: 1:1 augmentation (every cardiac cycle)
  • Can be adjusted to:
    • 1:2 (every other beat)
    • 1:3 (every third beat)
  • Weaning: Gradual reduction (1:1 → 1:2 → 1:3) over 6–12 hours
  • Note: In 1:3 mode, coronary perfusion benefit may be negligible.

Monitoring and Position Confirmation

  • Renal blood flow should improve post-insertion. Persistent oliguria or no improvement → suspect malposition.

Complications

  • Bleeding
  • Thrombosis
  • Limb ischemia
  • Aortic dissection
  • Infection
  • Balloon rupture → risk of helium gas embolism
  • Cardiac tamponade
  • Haemolysis

Pasted%20image%2020240701173329.png

View or edit this diagram in Whimsical.

Anticoagulation

  • Routine anticoagulation not required in 1:1 support.
  • Consider anticoagulation in 1:2 or 1:3 modes due to ↑ thrombotic risk.

ECG and Pressure Waveform Interpretation

Features

  • Augmented diastolic pressure: Post-inflation
  • Assisted systolic pressure: ↓ compared to unassisted
  • “V” shape at dicrotic notch = proper timing

Abnormal Waveforms

Early Balloon Inflation Results in Increased Afterload

Pasted%20image%2020240301125645.png

Late Balloon Inflation Results in Decreased Diastolic Augmentation

Pasted%20image%2020240301125701.png

Early Balloon Deflation Fails to Decrease Myocardial Oxygen Demand

Pasted%20image%2020240301125719.png

Late Balloon Deflation Increases Afterload

Pasted%20image%2020240301125739.png

Poor Diastolic Augmentation Results in Suboptimal Coronary Perfusion

Pasted%20image%2020240301125755.png

Early Inflation and Late Deflation Increase Afterload; the opposite Fail to Augment

Links

References:

  1. Krishna, M. and Zacharowski, K. (2009). Principles of intra-aortic balloon pump counterpulsation. Continuing Education in Anaesthesia Critical Care &Amp; Pain, 9(1), 24-28. https://doi.org/10.1093/bjaceaccp/mkn051
  2. Figaro R, Thornton I, Scott JP, Sluhoski J. Anesthetic Management of Intra-aortic Balloon Pump-Induced Systolic Anterior Motion of the Mitral Valve During Coronary Artery Bypass Grafting. Cureus. 2024 Mar 24;16(3):e56815. doi: 10.7759/cureus.56815. PMID: 38654781; PMCID: PMC11036903.
  3. FRCA Mind Maps. (2024). Retrieved June 5, 2024, from https://www.frcamindmaps.org/
  4. Anesthesia Considerations. (2024). Retrieved June 5, 2024, from https://www.anesthesiaconsiderations.com/
  5. ICU One Pager. (2024). Retrieved June 5, 2024, from https://onepagericu.com/

Summaries:
ICU_One_pager_IABP.pdf (squarespace.com)
IABP
Cardiothoracic anaesthesia video

Copyright
© 2025 Francois Uys. All Rights Reserved.

id: “58730334-30b9-4c56-8d96-bc6ccdbe7171”

The Brain (all notes)

Please log in to view your notes.

Related article

Load More