Intra-Aortic Balloon Pump - Opinions?

[KLPM]

Has anyone had much experiences with these? What are they good for? It seems our cardiothoracic surgeon puts a few of these in post-transplant along with loads of vasopressors. The patients that get these all seem to have poor cardiac function, high PA pressures, RV dysfunction and borderline oxygenation. The ICU guys hate it and they are all advocates of ECMO instead.

Before this year I've only ever seen it being used once so I didn't think much of it.

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[Idiopathic]

I wouldn't consider ECMO and IABP to be functional equivalents as in either/or. Balloon pumps are a way to augment the function and coronary perfusion in the failing heart, i usually reserve ECMO for the acutely FAILED heart

I will say that your post transplant patient doesn't seem like the ideal candidate for either as their functional status should be great (unless you are talking about lung transplant), but all the scenarios you describe are indications to consider IABP supplementation


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[Idiopathic]

If you are talking about lung transplants then I can see the value of having blood go through the lungs, and therefore, the desire to avoid VA ECMO


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[KLPM]

If you are talking about lung transplants then I can see the value of having blood go through the lungs, and therefore, the desire to avoid VA ECMO

Thanks. I am talking about heart transplants.

 

[Idiopathic]

well without knowing any of the details i will suggest that something is wrong if your post op heart transplants are requiring either IABP or ECMO support,

Now if the lungs are struggling (severe pulmonary edema, ARDS, etc) following transplantation, then I would consider V-V ECMO as a reasonable therapy, but I can also understand why that would not be ideal in the fresh heart transplant (anticoagulation, etc); however, i would not expect an IABP to be of benefit there.

Occasionally the pre-transplant patients are in such significant failure that they go into the OR with IABP in place; perhaps they are just left in, to be pulled when the patient is stable?

 

[bigtuna]

Actually, having an IABP in place is often necessary for patients on VA ECMO. Because the arterial perfusion is retrograde, often the LV will progressive dilate if an IABP is not in place to help unload the LV. There are other strategies for unloading the LV as well.

 

[urge]

Has anyone had much experiences with these? What are they good for? It seems our cardiothoracic surgeon puts a few of these in post-transplant along with loads of vasopressors. The patients that get these all seem to have poor cardiac function, high PA pressures, RV dysfunction and borderline oxygenation. The ICU guys hate it and they are all advocates of ECMO instead.

Before this year I've only ever seen it being used once so I didn't think much of it.

What kind of training do these ICU guys have? Seems odd that anybody would prefer ECMO.

 

[Stank811]

Agree with all of the above…we use them quite often either to help with coronary perfusion and decrease LV wall stress following a STEMI with PCI or to help decrease after load in a failing heart. In regards to heart failure at our institution if an IABP is not sufficient we will often transition to an Impella device and then if need be more invasive measures such as VA ECMO or VAD. I would also be curious to the benefit of IABP following heart transplant.

 

[Idiopathic]

Actually, having an IABP in place is often necessary for patients on VA ECMO. Because the arterial perfusion is retrograde, often the LV will progressive dilate if an IABP is not in place to help unload the LV. There are other strategies for unloading the LV as well.

never seen this, only seen an LV vent

 

[Idiopathic]

What kind of training do these ICU guys have? Seems odd that anybody would prefer ECMO.

i mean its sort of comparing apples and egg salad. ive never been confronted with the decision to use one or the other; the situation simply demands one or the other