Intra-aortic balloon pump

This is an overview of the intra-aortic balloon pump, covering the indications, contraindications, and the mechanism of how they work.
ADDITIONAL TAGS:
Simple, cost-effective, easy-to-implant device (by coronary cath) to mitigate the adverse outcomes of cardiogenic shock. Indications:
Acute congestive heart failure exacerbation with hypotension
Prophylactic or adjunct treatment in high risk PCI
Myocardial infarction with ↓ LV function leading to hypotension
MI with mechanical complications → cardiogenic shock, i.e., acute mitral regurgitation due to papillary muscle rupture or ventricular septal rupture
↓ CO after coronary artery bypass grafting surgery
Bridge to definitive treatment in: intractable angina or myocardial ischemia; refractory heart failure; or intractable ventricular arrhythmias
Contraindications to placement:
Moderate to severe aortic insufficiency
Aortic disease
dissection
aneurysm
"porcelain aorta"
trauma
pseudoaneurysm
Severe peripheral vascular disease unless pretreated with stenting
Severe aortic atherosclerotic plaque formation
Uncontrolled sepsis
Uncontrolled bleeding diathesis
IABP senses early diastole (sensing the dicrotic notch [aortic valve closure] or via ECG) and inflates:
Augments aortic diastolic pressures (D) and improve CPP
Balloon deflation → systolic "unloading" of the left ventricle, therefore rendering a lowered assisted aortic EDP (E) compared to unassisted (B)
Combined effect: ↑ myocardial oxygen supply and ↓ myocardial oxygen demand
IABP arterial waveform tracing:
Balloon inflation
C: unassisted systole
D: augmented diastolic pressure (which increases coronary perfusion pressure
B: unassisted aortic end diastolic pressure
E: assisted end-diastolic pressure

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