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Mechanical Effects of Cardiovascular Drugs and Devices
Published in Michel R. Labrosse, Cardiovascular Mechanics, 2018
Intra-aortic counterpulsation provides a minimally invasive method of support for failing left ventricular (LV) function by reducing afterload and improving myocardial oxygen supply–demand balance. However, the efficacy of counterpulsation depends on several factors, including intrinsic ventricular function. Counterpulsation therapy is produced by an intra-aortic balloon (IAB) and control system. The IABP consists of an inflatable balloon, which is placed in the aorta to improve cardiovascular functioning during certain life-threatening emergencies, and a control system for regulating the inflation and deflation of the balloon. The control system, which monitors and is synchronized with the electrocardiogram, provides a means for setting the inflation and deflation of the balloon with the cardiac cycle. The IABP provides counterpulsation therapy to adult patients with impaired LV function. The IAB is inserted via catheter into the femoral artery and positioned in the descending thoracic aorta 1–2 cm distal to the left subclavian artery. It provides hemodynamic support of blood pressure and reduced cardiac work through volume displacement principles.
Update on the management and associated challenges of adult patients treated with veno-arterial extracorporeal membrane oxygenation
Published in Expert Review of Medical Devices, 2019
Yuichiro Kado, Takuma Miyamoto, Kiyotaka Fukamachi, Jamshid H. Karimov
Several reports indicated that the use of intra-aortic balloon pumping (IABP) resulted in better outcomes. Doll et al. [19] reported that postoperative cardiogenic shock patients treated with IABP had a significantly higher survival rate. In this study, IABP was used in 66% of all patients, in 70% of patients who were weaned from ECMO, in 59% of patients who could not be weaned, in 73% of the long-term survivors, and in 63% of the nonsurvivors. Independent predictors of in-hospital survival included younger age, absence of preoperative myocardial infarction, absence of diabetes mellitus, and use of IABP. Smedira et al. [11] reported that patients with cardiac failure were more likely to be successfully weaned if IABP was used; 63% of the patients receiving IABP support were weaned compared with 49% of the patients withdrawn from ECMO. Santise et al. [20] reported that 72% patients were able to be weaned from VA ECMO and 44% patients were eventually discharged in total, while for those treated with IABP, 84% patients were successfully weaned and 53% patients were eventually discharged. All of their patients were diagnosed as primary graft failure after heart transplantation, and this was one of the strongest risk factors for mortality. Although some have abandoned the use of IABP with ECMO due to the increased risk of vascular complications, the use of IABP may increase SRR due to the benefit of raising coronary perfusion flow and reducing systemic afterload.