Intra-aortic Balloon Pump (IABP): Working, Procedure, Risks

What is an Intra-aortic Balloon Pump?

An intra-aortic balloon pump (IABP) is a mechanical machine that rises the oxygen (O2) perfusion to the heart and the heart’s muscle and also increases the blood flow (cardiac output). Increased cardiac output boosts the flow of the coronary blood, which increases the supply of O2 to the heart.

An intra-aortic pump is made up of a balloon locates in the aorta (the largest vessel and main arteries in the human body, located just below the heart). As the heart ventricles tighten and release the blood, then IABP deflates. This pump reduces resistance (afterload) behind the heart and increases blood flow forward. As the ventricle of the heart loosens (diastole) and fills with blood again, the pump actively expands and increases the flow of blood to the coronary arteries (the arteries that supply O2 to the heart). Combining these actions reduces the heart’s need for oxygen and improves the O2 delivery to the heart.

intra-aortic balloon pump (IABP)

During the working, the intra-aortic balloon pump balloon expands and depresses due to the reverse pulsation process. In simple words, it inflates during diastole and depresses aggressively during systole. With the help of the vacuum effect, the systolic deflation reduces the afterload and indirectly improves the anterior blood flow to the heart. The pump inflates during the diastole process and boosts the coronary arteries’ blood flow through the retrograde blood flow. Together, these processes (systolic and diastole) reduce myocardial O2 need and increase myocardial O2 (oxygen) delivery.

In this pump, Helium uses to inflate a balloon because of its low density and low turbulence. Therefore, the balloon can inflate quickly and depress gradually. If the balloon breaks or leaks then the Helium can also dislodge rapidly.

An intra-aortic balloon pump has a flexible, thin tube known as a catheter. A long balloon is attached to the catheter tip. This is known as an IAB (intra-aortic balloon). While a computer console connects with the other side of the catheter. This console is an equipment that inflates and depresses the balloon according to the heartbeat.

Read also: Different types of Pumps

How does an Intra-aortic Balloon Pump work?

The heart delivers nutrients and oxygen-rich blood to all parts of the body. The arteries use to discharge the blood from the heart and deliver the oxygen-rich blood into blood vessels. The heart gets nutrients and O2 from these vessels according to its need. There are also arteries in the heart’s outer wall that are known as the coronary arteries.

As the heart deflates, it pumps blood to the body. When it relaxes, blood moves inside the coronary arteries and carries O2 to the heart. IABP facilitates blood to move quickly to the coronary arteries. This pump also helps the heart to supply more blood with each contraction. However, it only increases the functionality of the left ventricle. This is because the left ventricle is the chamber that supplies blood to the aorta.

intra-aortic balloon pump working

Here is the working of an intra-aortic balloon pump:

  • First of all, insert the balloon into the aorta. The aorta is a lengthy artery that begins from the heart. Sometimes, this process also performs through a small incision on the inner side of the upper leg. Next, you or your doctor will require to insert a balloon pump catheter into the leg artery. After this, you need to bring it to your aorta.
  • After this, the IABP will start working. As the heart relaxes, the balloon inflates. It forces the blood back into the coronary arteries. These arteries can’t get adequate blood without a pump. When the heart shrinks, the balloon also shrinks. This shrinkage generates additional room in the aorta, which allows the heart to pump more blood. This process will reduce the stress on your heart. The pump will continue to expand and contract until it eliminates.

For a better understanding the working of IABP, watch the following video:

What are the risks for intra-aortic balloon pump therapy?

Treatment with IABP is beneficial. Sometimes it even saves lives. But it also has some risks that are given below:  

  • Infection due to insufficient blood supply to the limb (ischemia)
  • Arterial injury
  • Due to the low platelet count, the blood does not clot and may cause excessive bleeding.
  • Balloon explosion
  • Infections
  • Sometimes, the balloon doesn’t locate at its correct position or may change position inside the body; due to that patient may face kidney damage or other issues.
  • Treatment with IABP is uncomfortable. Therefore, if you install this device, you should calmly lie down on the hospital bed.
  • Stroke
  • The intra-aortic balloon pump can produce some side effects. For example, long-term use of IABP can create bloodstream infections. It can also produce blood clots and lead to severe issues like stroke. Sometimes, the balloon can become over-inflated, due to which the aorta ruptured.

The risks by this device depend on the patient age and other medical situations that a patient has

Components of IABP

An intra-aortic balloon pump has the following components:

components of Intra-aortic balloon pump

1) Balloon

The balloon uses to block the way of blood in the aorta at a specific point in time. That means it must be able to resist the pressure of the heart. It is made of a material that will not break or damage easily. This component of the intra-aortic balloon pump should be biocompatible.

2) IABP Console

A console is a monitoring machine. It is the source of gas for the IABP. This component requires for the balloon to deflate and inflate properly. It is also compulsory for the monitoring systems so that the monitoring system can also determine what stage the balloon is in so that it doesn’t expand at the wrong time and cause problems. This monitoring device utilizes an ECG (electrocardiogram) to regulate the stage of the heart. It uses helium to inflate the balloon as the aortic valve shuts and cardiac output and heart pressure increase.

3) Catheter

This component attaches the balloon with a transducer (outside the body) and a monitoring device (inside the aorta). It is a flexible tube that can insert into the body’s narrow opening. It uses to withdraw or introduce fluid.

4) Transducer

During the first test in 1962, the transducer was integrated into the IABP design. Its purpose was to transform signal or energy from one format to another and display it on a monitor for clarification. A transducer is compulsory for continuous blood pressure monitoring because the IABP uses a double notch in the aortic blood pressure curve to measure the time of expansion and contraction of the balloon.

How do I prepare for intra-aortic balloon pump treatment?

Before the treatment, you must talk with your healthcare provider. Your healthcare provider will provide detailed directions about your treatment.

If you are pregnant or suspect you may be pregnant, be sure to tell your doctor. And also, tell him/her if are facing:

  • Sedation problems
  • New symptoms like an unexpected fever
  • Any other diseases

Following are some instructions that you should follow for your intra-aortic pump treatment:

  • If you are a smoker, then you must stop smoking before the treatment. This can decrease the likelihood of complications.
  • You should also stop the use of medicine before the treatment. Sometimes, you may be needed to take medicine before and during therapy to stop blood clots.
  • Don’t drink or eat after 12 AM before the day of surgery.

Some other tests may require to measure your health beforehand. These can include:

  • Echocardiography (uses to check your heartbeat)
  • Basic blood test (assessment of anemia and infectious diseases)
  • Chest X-ray (uses to see the lungs and heart)
  • Electrocardiogram (uses to check heart rate)

What happens during intra-aortic balloon pump therapy?

In the intra-aortic balloon pump treatment, a balloon-tipped catheter inserts inside a vessel of the blood and advanced it to the heart. This process usually adopts during heart-related surgery. However, in emergencies, the medical team can put it at the bedside.

Your doctor can let you know exactly what will happen. In general, this treatment consists of the below-given steps:

  • Firstly, you may get few shocks. If this is inserting during your operation, then you are already facing the shocks. In this condition, you will fall asleep without feeling anything. During other conditions, you will get relaxation medication that will be helpful for you.
  • Heart rate, blood pressure, and other vital signs will also monitor throughout the surgery.
  • A small incision will be generated through the artery in your inner thigh’s upper section. Insert a balloon catheter there.
  • The surgeon advances the catheter up to part of the aorta in the chest. This movement may monitor through a continuous X-ray image.
  • The balloon will start to inflate as the heart relaxes. When the heart contracts then it contracts
  • The catheter’s end is a secure place; therefore, the balloon will place there.

Your chest may hurt a little after the operation. It may go away within a few minutes of starting the IABP. However, further treatment may be required if symptoms persist.

Your doctor will be there if you will face any problems. You may need to rest in bed for some time. Raise the head of the bed a little bit. Keep the leg into the catheter insertion and keep it straight. This will prevent the balloon from moving in place. A daily chest X-ray may require to make sure that the balloon is in its proper position. Pumps often make noise by expanding and contracting repeatedly.

What happens after intra-aortic balloon pump therapy?

You may need to keep the pump “ON” for many days. Your doctor will continuously observe this. Your healthcare provider can temporarily stop the balloon pump to see your reaction after turning it off. Alternatively, he/she can customize it up so that it only expands and contracts with every 3 or 5 heartbeats. If your heart starts to pump blood on its own without a balloon, you should stop the intra-aortic balloon pump treatment. Treatment can also be stopped if other interventions are accessible (e.g., heart donation).

If you need to remove the balloon, you may be given relaxation medication. Then the doctor will eliminate the catheter and the balloon connected to it. The doctor also closes the cut in your leg during the pump elimination.

He/she can hand you some more instructions about the expected result. If you will obey them gently, you will increase the likelihood of positive results.

How to use an intra-aortic balloon pump

An IABP (intra-aortic balloon pump) is a balloon pump that is designed for people who have severe heart problems (such as congestive heart failure and heart attack, etc.) or are expecting a heart transplant.

This procedure needs the settlement of a catheter with the intra-aortic balloon. This balloon inserts into the body’s artery, typically into the groin and then into the aorta (body’s largest artery). After this, connect the catheter to a computer that monitors the deflation and inflation, pressure, and time for the balloon to inflate as the heart muscle relaxes and contracts before the heart pumps blood again. This procedure is known as “counterpulsation”. This will help your mind in the following ways:

When the heart relaxes, a pump at your bedside inflates the aortic balloon so that oxygen-rich blood can easily reach the heart. The pump then deflates the balloon just before the heart is ready to pump this oxygen-rich blood. This reduces the pressure in the aorta and helps the heart to move blood around the body more easily.

As the heart is stable and able to work normally, remove the IABP and catheter and apply pressure to stop the bleeding.

Advantages of IABP

  • An IABP permits blood to move more easily into the coronary arteries.
  • It helps your heart pump more blood with each contraction.
  • It boosts diastolic coronary
  • This device also rises the systemic flow of the blood
  • It reduces afterload and myocardial work

FAQ Section

What is the Purpose of Intra-aortic Balloon Pump (IABP) therapy?

An intra-aortic balloon pump (IABP) therapy has the following major purposes:

  • This treatment uses to boost myocardial oxygen delivery
  • It uses to reduce the myocardial oxygen need
  • It increases the pressure of coronary perfusion
  • Improve the cardiac output (CO)

Who invented Intra-aortic Balloon Pump?

Numerous anecdotal tried to develop IABP from a long time but the first IABP was developed in the 1950s.  In 1960, Kantrowitz clinically launched the first intra-aortic balloon pump.

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