Intraaortic Balloon Pump Counterpulsation, Part I: History, Technical Aspects, Physiologic Effects, Contraindications, Medical Applications/Outcomes

Abstract

Intraaortic balloon pump counterpulsation is the most common form of mechanical circulatory support used in patients with myocardial ischemia and cardiogenic shock. The physiologic principles of counterpulsation include diastolic augmentation of aortic pressure and systolic reduction of left ventricular afterload, resulting in hemodynamic benefits through increased coronary perfusion pressure and improved myocardial oxygen balance in patients with myocardial ischemia. Major trials have failed to conclusively demonstrate improvements in morbidity and mortality with counterpulsation therapy for patients with acute myocardial infarction (MI), cardiogenic shock, and/or severe coronary artery disease undergoing revascularization therapy, and the debate over its applications continues. Part I of this review focuses on the history of the development of counterpulsation, technical considerations, and complications associated with its use, its physiologic effects, and evidence for its use in myocardial ischemia and cardiogenic shock.

Mechanical circulatory support: complications, outcomes, and future directions

“…1 Vascular injuries remain the most common complication during insertion, with a 5% to 10% incidence. 2 When compared with patients not undergoing MCS therapy, IABP placement did not increase the risk of major bleeding, but did have increased vascular complication rates. 3 Risk factors that increase the risk of vascular injury are peripheral vascular disease, diabetes, female sex, advanced age, use of large insertion sheaths, and prolonged IABP support.…”

Mechanical circulatory support in acute myocardial infarction complicated by cardiogenic shock

“…It is absolutely contraindicated in patients with severe aortic regurgitation or aortic dissection. Complications occur with a frequency of about 5% during or following IABP insertion [54]. These complications are mainly vascular related to trauma or dissection and can manifest itself as haematoma, haemothorax, compartment syndrome, limb or organ ischaemia either acutely or insidiously.…”

Mechanical Cardiac Circulatory Support: an Overview of the Challenges for the Anesthetist

“…It is an endovascular catheter with a distal balloon positioned in the aorta distal to the origin of the left subclavian artery. It works on the principle of counterpulsation against intrinsic pulsatile left ventricular activity to augment the diastolic blood pressure and myocardial oxygen delivery as well as reduce myocardial oxygen demand [2]. Traditionally, the IABP has been used in acute myocardial infarction (MI), MI induced complications (e.g.…”