Intraaortic Balloon Pump Timing Discrepancies in Adult Patients

Abstract

The objective of this clinical study was to quantify the incidence and magnitude of intraaortic balloon pump (IABP) inflation and deflation landmark discrepancies associated with the IABP catheter arterial pressure waveform. Cardiac surgery patients with an IABP inserted prior to surgery were recruited. Following cardiac exposure, a high-fidelity pressure catheter was inserted into the aortic root for digital recording. The radial artery pressure signal was simultaneously recorded from the patient monitor along with the arterial pressure and electrocardiogram waveforms from the IABP console while operating at 1:1 and 1:2 synchronization. In selected patients, recordings were obtained with the IABP timed to the high-fidelity aortic root waveform. In all 11 patients, inflation and deflation landmark delays were observed when comparing the aortic root waveforms to the IABP arterial pressure waveforms (inflation delay = 74 ± 29 [23-117] ms; deflation delay = 71 ± 37 [24-141] ms, mean ± standard deviation [min-max]). Delays were greater when compared to the radial artery waveform (inflation delay = 175 ± 50 [100-233] ms; deflation delay = 168 ± 52 [100-274] ms). In all cases, the landmark delays were statistically different from zero (P < 0.001). Diastolic augmentation and afterload reduction varied with waveform source. Conflicting indications of afterload reduction occurred in four patients. Timing to the aortic root waveform resulted in greater diastolic pressure augmentation and afterload reduction but mixed changes in stroke volume. Delay and distortion of the arterial waveform was consistently found when measured through the IABP catheter lumen. These delays can alter IABP efficacy and may be eliminated by using high-fidelity sensing of aortic pressure.

End-diastolic flow reversal limits the efficacy of pediatric intra-aortic balloon pump counterpulsation

“…An aortic root pressure waveform transduced by a high-fidelity catheter results in a more precise waveform morphology with a more pronounced dicrotic notch, less signal gain, and less phase distortion 3 . Consequently, a high-fidelity signal was presumed to enable more accurate inflation and deflation timing of the IABP.…”

Current and future applications of the intra-aortic balloon pump

“…Other trigger events use the pacing spikes of ventricular or atrioventricular pacemakers [50]. In a recent study of cardiac surgery patients, the arterial pressure waveforms in the aortic root, the radial artery and the descending aorta were compared [51]. Inflation and deflation delays were observed when comparing the high-fidelity aortic root waveforms with the IABP arterial and radial artery catheter-derived pressure waveforms.…”

Feasibility of Subcutaneous ECG Leads for Synchronized Timing of a Counterpulsation Device

“…10,25 A longer timing error can produce adverse effects by increasing ventricular afterload during systole and diminishing coronary and end-organ flow during diastole. In this study, 150 ms was selected as a metric for evaluating sensitivity and specificity of Symphony timing (control algorithm), which is consistent with values reported in literature for IABP 3,22 and in accordance with ANSI/AAMI EC 57 standard. Unlike IABP, timing with the Symphony is a lot more forgiving.…”