Intra-Aortic Balloon Pump Therapy (IABP)

 Introduction:

           An Intra-Aortic Balloon Pump (IABP) is a type of therapeutic device which helps the heart to pump more blood when it is needed. That is when the heart is unable to pump enough blood, this device will come into action with the help of the physicians. This process is used when the body undergoes any cardiogenic shock.

Fig.1: whole setup of IABP therapy

First invented and used by:-

The IABP therapy was first invented by “Adrian Kantrowitz” an American surgeon in the year 1967. Its first clinical application was implemented successfully to a forty-five-year-old female who had sustained a myocardial infarction.

Fig.2: Adrian Kantrowitz- inventor of IABP therapy

Constructions:-

The IABP device has two important portions: they are,

1) A large-bore catheter with a long sausage-shaped balloon at the distal end.

2) A console containing a pump that inflates and deflates the balloon.

Steps to be followed in the console:-

• First power on the balloon pump by pressing the button in the console. After receiving lines from the sterile field, insert its cables to the console from where the helium is shuttled back and forth. And the fiber optic cable is connected which measures the blood pressure directly from the tip of the balloon catheter. The EKG and the pressure monitoring lines are connected at the proper place in the console. Lines from the patient’s monitor are also ducked down on the console.

• After the connections are made and the power is set ON, the EKG and the pressure traces are seen in one of the two screens. In the upper screen, the two traces, beats per minute, and the diastolic and systolic pressure after it is calibrated with the pressure transducer are seen. The lower line represents the augmentation or the balloon inflation and deflation. In the lower screen the trigger, the trigger source, the ballooning frequency, augmentation, and timing are all controlled. And the device is started by pressing the button on the screen and standby to pause it.

• Hence the balloon is controlled by the console according to the needs of the patients and under the supervision of the physicians.

Fig.3: A console used for IABP therapy

Insertion of balloon catheter:

• Usually, the intra – aortic balloon catheter is inserted through the femoral artery and it goes all the way to the heart through the our iliac artery, descending aorta and it sits right around the descending aorta starting below the subclavian artery and the outer tip goes right to the renal arteries.

• This is the reason why the urine outputs are constantly measured and monitored, as there is a good chance if things go wrong as the balloon pump can damage the renal arteries, destroying or harming the kidneys of the patients. Since special care is taken while inserting the device and should be done by well-trained people.

 Fig.4: Insertion of a balloon catheter

Working:-

The main function of the device is that contraction and relaxation (systole and diastole). It also reopens the blocked artery near the heart and it is just the reverse to the normal pumping action of the heart. In the sense that the device relaxes when the heart muscle relaxes(diastole) and contracts when the heart muscle contracts(systole) and reducing the afterload which is one of the main functions of the IABP device.

Fig.5:  The balloon contract and relax in accordance with diastole and systole

The balloon catheter is connected to the console for the purpose of inflating and deflating the balloon according to the rhythm of the heartbeat. In this process, helium is used to blow up the balloon. 

And the helium here is safe and it won’t cause any problems to the body if it leaks somewhere. 

IABP also provides modest ventricular unloading while also increasing mean arterial pressure and coronary blood flow.

 Fig.6: Helium cylinder fixed inside a console

In a properly timed waveform, the inflation point lies at or slightly above the dicrotic notch. The amount of aid a balloon pump can provide a quantified ratio of 1:1. 

Fig.7: The waveforms formed during the process

It is mostly used for two to a few days alone but it can stay in place for up to a month. For this process, the IABP uses helium to inflate the balloon as it is low density and means there is little turbulent flow. So the balloon inflates fast deflate slowly but as soon as any leak or rupture in the balloon, it is eliminated quickly.

Fig.8: A physician inserting the catheter into the patient model

Some medical disorders which require IABP therapy:-

• Unstable angina 
• Heart attack
• Certain abnormalities in heart rhythms
• Heart failure
• Other heart defects

    Fig.9: Figure showing stable and unstable angina

Fig. 10: An  image depicting a person with a heart attack

Future use of IABP Therapy:-

Intra - aortic balloon pumps have been used for many heart conditions for the part of forty years. In general, the device is used for the problems such as transient angina, arrhythmia, and myocarditis. The currently completed researches are for the use of IABP before surgery or for conditions that do not normally require the use of  IABP for treatment. Some researchers have suggested that the IABP could be used as a great support in high-risk cardiac surgery, meaning that if a patient has a heart transplant, IABP can be used in the body after a new heart transplant to reduce stress.

This is important because heart transplantation is difficult for the body and the surgeons need to make sure whether it fits the body. With some support, it can put less pressure on the patient and the implant can be inserted properly into the body. Another proposed idea for IABP is to use it to treat left ventricular obstruction on extracorporeal membrane oxygenation. Extracorporeal membrane oxygenation is life support commonly used in infants, children, and adults with heart conditions.

It is a form of heart-lung bypass, which means it takes over the function of the heart and lungs during the surgery. Researchers hope that IABP will help with inflammation of the ventricles in this process. This means that there is less chance of a negative reaction to this bypass procedure. Overall the future of IABP seems to be related to whether or not it is approved for use in patients with disorders other than the specific heart conditions listed. 

Researchers have made a great effort to use the intra-aortic balloon pump for a variety of procedures that can help patients in an amazing way.

Advantages of IABP Therapy:-

• It is available all over the world in most cardiac catheterization laboratories and in other required laboratories.
• It is easy for percutaneous implantation.
• It is available in several sizes like 7fr, 7.5fr, and 8fr according to the needs and for minimizing the thread of vascular complications.
• For the purpose of neglecting risks associated with a fluid-filled pressure line, contemporary systems use fiber optic technology.
• The newer systems are usually calibrated automatically in vivo accelerating the time to effective diastolic augmentation.
• A wide range of balloon sizes is available to accommodate the need of patients of all heights.
• This therapy involves safe and quick insertions.
• Big size balloons displace more blood providing enhanced diastolic augmentation and systolic unloading.

Disadvantages of IABP Therapy:-

• This device can able to only supplement cardiac outputs up to 0.3-0.5 I/min and it requires a degree of native cardiac output to function.
• There is a risk of balloon displacement, rupture, leak, and entrapment.
• Relies on synchronization with the cardiac cycle to circulatory support may not be reliable with dysrhythmia.
• There is a disadvantage of twisting/kinking and clot formation in the pressure line or catheter.
• A small but tangible risk of aortic dissection or rupture.
• It has a risk ok systemic embolization (e.g. cholesterol, helium)
• Sometimes it may cause a stroke.
• And also it causes some abnormalities like infection, lower limb ischemia, hemolysis, and bleeding at the insertion site.

Applications:-

• IABP device acts as hemodynamic support in medical conditions.
• And also acts as prophylactic hemodynamic support.
• Cardiac support for hemodynamically challenged patients with mechanical defects prior to correction.
• It is a mechanical device used to assist cardiac circulatory function in patients suffering from cardiogenic shock, congestive heart failure, refractory angina and complications of myocardial infarction, etc...  

Some manufacturers of IABP devices:-

• SENKO MEDICAL INSTRUMENTS Mfg. co., ltd
• Teleflex corporation
• Insight Medical, Inc
• Tokai medical products Inc
• Zeon corporation

Article Contributors:-

1. Snekha. R:- https://www.linkedin.com/in/snekha-r-0b68051b0

2. Sindhuja. G:- https://www.linkedin.com/in/sindhuja-g-796b0821b

3. Ranjani.S:- https://www.linkedin.com/in/ranjani-s-4b299821b