Intra-aortic Balloon Pump Device Research Articles

Comparison of the effect of 1:1 and 1:2 frequencies of intra-aortic balloon pump on hemodynamics of the patients undergoing coronary artery bypass graft surgery.

Some patients require intra-aortic balloon pump (IABP) after coronary artery bypass graft (CABG) surgery. IABP can be adjusted to different frequencies such as 1:1, 1:2, or 1:3. In this study, we tried to compare the effect of 1:1 and 1:2 frequencies of IABP on hemodynamic status of the patients after CABG surgery. In this experimental study, all patients using IABP after CABG surgery were entered the study as pretest and posttest groups. The study could not be blinded because of the clearness of posttest group for the same echocardiographist. The pretest group included patients using a 1:1 frequency of IABP device. The posttest group included patients in the pretest group who were exposed to a 1:2 frequency for 20 minutes. In both groups, on the moderate dose of inotropic support, hemodynamic parameters of patients including systolic blood pressure (SBP), diastolic blood pressure (DBP), mean arterial pressure (MAP), heart rate (HR), cardiac output (CO), cardiac index (CI), stroke volume (SV), and velocity time integral (VTI) in the aorta during systole were measured. Both groups were compared using Wilcoxon signed rank test. SPSS software was used for analysis and P < 0.05 was considered to be statistically significant. Twelve patients were entered into the study. Three patients were excluded because of open chest and instability of vital signs. Nine patients completed the study. 3 patients were men and 6 were women. The mean age was 58.32 ± 13.18 years. MAP in 1:1 frequency was significantly higher than 1:2 (P = 0.043); however, there was no significant difference between 1:1 and 1:2 in other hemodynamic parameters, namely CO, CI, SV, HR, and VTI. In patients on moderate dose of inotropes, IABP frequencies of 1:1 and 1:2 have the same effect on hemodynamic parameters such as CI, SBP, DBP, HR, and left ventricular outflow tract (LVOT) VTI; meanwhile, MAP remains higher in 1:1 frequency.

BIO26: Evaluation of the Hemocompatibility and Efficacy of Counterpulsation Support Provided by the NuPulse Intra-Aortic Balloon Pump Device in an Ovine Model

BIO26: Evaluation of the Hemocompatibility and Efficacy of Counterpulsation Support Provided by the NuPulse Intra-Aortic Balloon Pump Device in an Ovine Model

A Comparison of Success Rate in Off-Pump Coronary Artery Bypass Grafting Surgery among Patients with Varying Preoperative Left Ventricular Ejection Fractions: Retrospective Observational Study

Background: Off-pump coronary artery bypass grafting (OPCAB) is an alternative to coronary artery revascularization and avoids the complications of cardiopulmonary bypass (CPB). The procedure’s success, however, depends on intraoperative hemodynamic stability. Preoperative cardiac function can predict the tolerance to compromised hemodynamics during cardiac surgery. Inability to manage hypotension and low cardiac output while manipulating the heart is the most frequent cause of intraoperative conversion to CPB. Objective: The authors investigated the effects of the preoperative left ventricular ejection fraction (LVEF) on the success of OPCAB surgery and the relation of intraoperative factors to the success of OPCAB surgery. Material and Methods: Medical records of 284 patients who underwent OPCAB surgery in Ramathibodi Hospital between January 2015 and December 2017 were retrospectively reviewed. Preoperatively, the patients were classified into groups 1 to 4 based on LVEFs of 50% to 70%, 40% to 49%, 30% to 39%, and &lt;30%, respectively. Preoperative characteristics were collected. Intraoperative success of OPCAB surgery, application of inotropes, vasopressor, fluid, and intra-aortic balloon pump (IABP), and post-operative outcomes were analyzed and compared among the four LVEF groups. Results: No significant differences in success of OPCAB surgery emerged among the four groups (p=0.430). Intraoperative requirements of IABP were significantly higher for LVEF &lt;30% patients (p=0.001). In addition, the time to extubation was significantly delayed (p=0.001) and the LVEF &lt;30% patients stayed longer in intensive care unit (ICU) (p=0.002) when compared with the good LVEF patients. There were no significant differences in the operative time, amount of intravenous fluid, blood transfusion requirement, or blood loss among the groups. There were no significant differences in major postoperative morbidities. Conclusion: OPCAB surgery can be performed successfully in patients with severe cardiac dysfunction (LVEF &lt;30%) without significant differences from LVEF ≥30% patients, although the need for an intraoperative IABP device and inotropic drugs for hemodynamic support were greater and the extubation times and ICU stays were longer. Keywords: Coronary artery bypass graft; Left ventricular ejection fraction; Off-pump CABG; OPCAB; Poor cardiac function

An Interaction Effect Analysis of Thermodilution-Guided Hemodynamic Optimization, Patient Condition, and Mortality after Successful Cardiopulmonary Resuscitation.

Proper hemodynamic management is necessary among post-cardiac arrest patients to improve survival. We aimed to investigate the effects of PiCCO™-guided (pulse index contour cardiac output) hemodynamic management on mortality in post-resuscitation therapy. In this longitudinal analysis of 63 comatose patients after successful cardiopulmonary resuscitation cooled to 32–34 °C, 33 patients received PiCCO™, and 30 were not monitored with PiCCO™. Primary and secondary outcomes were 30 day and 1 year mortality. Kaplan–Meier curves and log-rank tests were used to assess differences in mortality among the groups. Interaction effects to disentangle the relationship between patient’s condition, PiCCO™ application, and mortality were assessed by means of Chi-square tests and logistic regression models. A 30 day mortality was significantly higher among PiCCO™ patients, while 1 year mortality was marginally higher. More severe patient condition per se was not the cause of higher mortality rate in the PiCCO™ group. Patients in better health conditions (without ST-elevation myocardial infarction, without cardiogenic shock, without intra-aortic balloon pump device, or without stroke in prior history) had worse outcomes with PiCCO™-guided therapy. Catecholamine administration worsened both 30 day and 1 year mortality among all patients. Our analysis showed that there was a complex interaction relationship between PiCCO™-guided therapy, patients’ condition, and 30 day mortality for most conditions.

Six-Month Post-Transplant Outcomes in Patients Bridged to Heart Transplantation with IABP or Impella Following 2018 UNOS Allocation Policy Change

Purpose We sought to compare six-month post transplantation survival among patients with Impella Devices versus intraaortic balloon pump (IABP) while on the waitlist during the year that followed the 2018 UNOS Allocation Policy change. We also compared waitlist outcomes at six months between the two groups. Methods All adult patients who were listed for heart transplantation for one year after the UNOS 2018 allocation policy change who had an IABP (n=682) or Impella device (n=65) were analyzed. Kaplan-Meier survival analysis was performed on patients who received heart transplantation. Baseline characteristics were compared using Mann-Whitney U test and Chi-square test as appropriate. Competing outcomes analysis was performed to compare heart transplantation or recovery, death or deterioration, or continuation on the waitlist at six months between the two cohorts. Results At 180 days, patients with an Impella while listed for transplantation had lower median waitlist times than patients with an IABP (median+IQR) (8.0 days[4.0, 18.0] vs. 11 days[6.0, 28.0], p = 0.013) and a greater proportion received heart transplant or achieved recovery (76.8% vs. 68.0%, p = 0.005). There was no difference in survival at 180 days post transplantation (Impella 92% [86%, 99%] vs. IABP 94% [91%,95%]), death or deterioration prior to transplant (10.7% vs. 11.0%, p = 0.943), or continuation on the waitlist (12.5% vs. 20.5%, p = 0.185). Conclusion In the year following the 2018 UNOS allocation policy change there was no difference in six month survival post heart transplantation between patients with IABP or Impella devices while waiting. Though there was a larger proportion of patients who recovered or were transplanted in the Impella cohort at six months, incidence of death or deterioration prior to transplant, or continuation on waitlist between Impella and IABP cohorts were not significantly different. Further study is warranted to understand the implications of these approaches in the context of the policy change.

Journal of Endovascular Resuscitation and Trauma Management: A Timely Endeavor

It is with great pleasure that the editorial staff of the Journal of Endovascular Resuscitation and Trauma Management (JEVTM) welcomes your review of – and participation in - our exciting new endeavor. This initial release of JEVTM represents the beginning of the first medical journal specifically dedicated to the examination of endovascular applications as tools for resuscitation, hemorrhage control and definitive trauma management. It is an ambitious undertaking, but one who’s time has come. Why is now the right time for the initiation of JEVTM? The answer to this question involves an examination of several key concepts. These include the emergence of new technologies, changing clinical practices and a growing body of multi-disciplinary innovators dedicated to the exploration and study of an expanding set of endovascular capabilities. Emerging Technologies&#x0D; The past several decades have born witness to an evolution in endovascular technologies. While many of these innovations were initially developed with the treatment of atherosclerotic and aneurysmal vascular disease pathologies in mind, the applications for hemorrhage control and vascular injury management were quickly appreciated. Endovascular balloons, known to potentially improve outcomes from ruptured abdominal aortic aneurysms, are now increasingly utilized as tools for bleeding control from non-compressible sites following trauma. Angio-embolization has become a mainstay of treatment capabilities for both pelvic and solid organ injury at most busy trauma centers. Endovascular stent grafts have emerged as the acute treatment of choice for blunt thoracic aortic injuries. Additionally, other endovascular adjuncts, including extra-corporeal membrane oxygenation (ECMO) and intra-aortic balloon pump devices, continue to evolve as tools of modern resuscitation. Initially, many of these advances were achieved using devices that were largely designed for the management of chronic vascular disease. Increasingly, however, devices and capabilities are being engineered to specifically optimize their utilization for victims of trauma and other patients in need of resuscitative salvage. Continued engineering advancements and efforts to define optimal clinical utilization of these devices will require a platform for reporting and critical review. It is our hope that JEVTM will serve as an effective vehicle for this study.Changing Practices&#x0D; With the increasing inclusion of endovascular capabilities in algorithms for hemorrhage control, resuscitation and trauma management other questions regarding practice have emerged. What provider is best suited to employ these technologies? How should they be trained? What expertise is required? The answer to these questions have not been well elucidated, even as the use of endovascular technologies continues to grow. Beyond the type of providers that should be involved, there also remain questions about the optimal care environment in which these technologies should be delivered. Is a hybrid-operating suite the optimal environment? How much imaging capability is really required? Can some of these capabilities safely be brought to the pre-hospital care environment? These questions are matters of active investigation that require a venue like JEVTM for examination.A multi-disciplinary collaboration&#x0D; The foundation for the creation of JEVTM can be traced to discussions that culminated in the February 2017 Endovascular Hybrid and Trauma Management Meeting in Orebro, Sweden. This gathering, sponsored by the University of Orebro, brought together thought leaders from nations throughout Europe, North America and Asia. Their diversity in geographic representation was second only to their diversity of training backgrounds. Interventional radiologists, emergency medicine physicians and surgeons (vascular, trauma and acute care) shared their clinical experiences with not only each other – but also a large group of translational scientists working diligently to provide important foundational data for next steps in endovascular applications. In the context of this excellent exchange, many of these multi-disciplinary participants discussed work that had been presented at prestigious meetings and had been published in a wide array of medical journals scattered across a variety of disciplines. It became apparent, however, that there was a need for a platform that might serve as a common ground for this diverse group of providers striving to advance the safe and effective use of endovascular technologies in resuscitation and trauma management. It is our hope that the Journal of Endovascular Resuscitation and Trauma Management serves as that needed platform.&#x0D;

Complications of intra-aortic balloon pump use: does the final position of the IABP tip matter?

We report results of a retrospective review of intra-aortic balloon pump (IABP) use in two Australasian centres and evaluate the effect of final IABP tip position on outcome. Indications for counterpulsation, patient demographics and in-hospital outcomes and complications were retrospectively collected. The chest X-ray reports provided the 'final' position of the IABP tip. The position was defined as acceptable (tip was seen just below the aortic arch, at T2-T5 vertebrae), malpositioned (tip > 5 cm below aortic arch or at T5-T6) or severely malpositioned (tip > 10 cm below aortic arch or at T7 or below).?Major complications were considered a composite of death secondary to IABP, major limb ischaemia, major IABP malfunction, balloon rupture or haemorrhage, severe renal dysfunction (rise in creatinine > 200 µmol/l), stroke and mesenteric ischaemia. Six hundred and forty-five cases were reviewed. The overall major complication rate was 26.2% and 24.3%. Severe renal impairment was the most common complication (16.6%), and second, severe catheter dysfunction (5.4%). ?Final IABP position was acceptable in 39.9%, malpositioned in 11.1%,?severely malpositioned in 6.7% and unavailable for 42.4%. Logistic regression analysis showed IABP tip malposition (compared with satisfactory position odds ratio=3.9 [95% confidence interval=2.0-7.6, P < 0.001] and severely malpositioned odds ratio=13.0 [95% confidence interval 5.3-31.7, P < 0.001]) was associated with major complications more than the presence of shock (odds ratio=3.8, confidence interval=2.1-6.8 P < 0.001). The acceptance of a less-than-ideal final position was highly predictive of morbidity directly related to IABP device therapy.

Early application of an intra-aortic balloon pump in patients with ST-segment elevation acute myocardial infarction scheduled for elective percutaneous coronary intervention

This study evaluated the effect of early application of intra-aortic balloon pump (IABP) counterpulsation in patients with ST-segment elevation acute myocardial infarction (STEMI), scheduled for elective percutaneous coronary intervention (PCI). Patients who had experienced STEMI for 12-72 h received (IABP group) or did not receive (control group) IABP counterpulsation for 3-5 days before PCI. One hundred patients were included. Frequencies of infarct-related artery thrombolysis in acute myocardial infarction (TIMI) flow rate classes 0, I and II in the IABP group (11.5, 1.9 and 7.7%, respectively) were significantly lower than in the control group (29.1, 14.6 and 22.9%, respectively) before PCI. After PCI, the frequency of TIMI class III flow rate in the IABP group (96.2%) was significantly higher than that in the control group (81.3%). Four weeks after PCI, the left ventricular ejection fraction (LVEF) was significantly higher, and the incidence of major cardiac events was significantly lower, in the IABP group compared with the control group. Early use of IABP counterpulsation in STEMI patients scheduled for PCI was effective, with a favourable safety profile. IABP counterpulsation reduced the incidence of major adverse cardiac events and improved LVEF. However, IABP devices must be used at an early stage, to obtain optimal results.

PulseCath, a new short-term ventricular assist device: our experience in off-pump coronary artery bypass graft surgery

We utilized a new ventricular assist device, the PulseCath catheter, to perform an off-pump bypass procedure in a patient with low ejection fraction. The 21 Fr PulseCath catheter, driven by a standard intra-aortic balloon pump console, can generate a pulsatile flow of 2-3 l/min. The PulseCath coupled with an intra-aortic balloon pump device is an important tool for left ventricular assistance.

The effect of intra-aortic balloon counterpulsation on left ventricular functional recovery early after acute myocardial infarction: a randomized experimental magnetic resonance imaging study

We sought to determine whether intra-aortic balloon pump (IABP) counterpulsation improves the recovery of left ventricular (LV) systolic function after reperfused acute myocardial infarction (AMI). Fourteen dogs underwent 90-min coronary artery occlusion followed by reperfusion. Seven animals were randomized to IABP counterpulsation immediately after reperfusion. Tagged, cine, and contrast-enhanced magnetic resonance imaging were used for regional and global LV functional assessment and MI characterization, respectively. Image acquisition was performed at 1 h, 6 h, and 24 h after reperfusion, during which the IABP device was paused. Animals randomized to IABP demonstrated an earlier improvement of LV ejection fraction when compared with controls (25+/-3 vs. 25+/-2% at 1 h, P=0.91; 36+/-3 vs. 26+/-2% at 6 h, P=0.015; and 38+/-3 vs. 35+/-1% at 24 h, P=0.34). Regional functional analyses revealed the same behaviour among non-infarcted risk regions, i.e., earlier circumferential systolic strain improvement in the IABP group than in controls (-5.4+/-0.4 vs. -5.3+/-0.5% at 1 h, P=0.86; -12.1+/-1.0 vs. -6.0+/-0.4% at 6 h, P<0.001; and -13.9+/-1.1% vs. -12.8+/-0.6% at 24 h, P=0.40). Importantly, however, the degree of LV functional recovery 24 h after reperfusion was similar whether IABP counterpulsation was used or not. IABP counterpulsation accelerates but does not significantly improve the recovery of LV systolic function after reperfused AMI.

The incidence and risk of acute renal failure after cardiac surgery

Objective: To evaluate outcome and risk factors of acute renal failure in a surgical population with or without preoperative renal dysfunction. Design: Observational study. Setting: Intensive care unit at a University Hospital. Participants: Five thousand sixty-eight consecutive adult patients who underwent cardiac surgery with cardiopulmonary bypass. Interventions: Perioperative variables measured were age, sex, basic pathology, preoperative renal impairment defined as creatinine >1.4 mg/dL, ventricular dysfunction, preoperative neurologic event, chronic obstructive pulmonary disease, diabetes, type of surgery, use of intra-aortic balloon pump (IABP), cardiopulmonary bypass (CPB) duration, redo or emergency surgery, hemorrhage, blood transfusion, surgical revisions, and postoperative complications. Measurements and Main Results: Acute renal failure (100% creatinine increase) developed in 171 (3.4%) patients, whereas 94 patients (1.9% of the population) had renal replacement therapy. Hospital mortality was 40.9% in patients with acute renal failure and increased to 63.8% when renal replacement therapy was requested. Sex, age, emergency surgery, low ejection fraction, IABP device, redo, diabetes, mitral valve surgery, CPB duration, and preoperative renal disease were independently associated with acute renal failure at a multivariate analysis. Conclusion: This study confirms that acute renal failure is one of the major complications of cardiac surgery, identifies the risk factors, and suggests that optimizing cardiac output and reducing CPB time could improve the outcome of patients at high risk of acute renal failure.

Em-2. Use of an Intra-Aortic Balloon Pump Device by an Emergency Physician in a Patient in Cardiac Arrest

em-2. Use of an Intra-Aortic Balloon Pump Device by an Emergency Physician in a Patient in Cardiac Arrest

Ambulatory intraaortic balloon pump use as bridge to heart transplant

Background. This study evaluates a modification of an ambulatory intraaortic balloon pump (IABP) technique used in patients with heart failure of ischemic origin for bridge to transplant. Methods. In this retrospective review we evaluated the ability to place the ambulatory IABP, any complications, time on device, and success in bridging to transplant on the ambulatory IABP device. In addition, the cost as compared to current ventricular assist devices was determined. Results. Between July 2000 and November 2001, 4 patients have been managed with ambulatory IABP in our combined University of Wisconsin and William S. Middleton Veterans Administration programs. All 4 patients had ischemia as their mode of heart failure, and each had a relative contraindication to standard ventricular assist device use. All 4 patients had ambulatory IABPs successfully placed through the left axillary artery without complication, and were able to ambulate early after ambulatory IABP placement, and increased their rehabilitation status before transplantation. Ambulatory IABP support ranged from 12 to 70 days. All 4 patients have been successfully transplanted and discharged from the hospital. Use of the ambulatory IABP support, even with multiple replacements, translated to 10- to 50-fold savings for each of the reported patients versus standard ventricular assist device use. Conclusions. As a result of our initial experience, we believe that ambulatory IABP is an excellent mode of support in selected patients, and is cost-effective, as compared to conventional ventricular assist device therapy.

Evaluation of Driving Characteristics of Linear Motor-Driven Intra-Aortic Balloon Pump.

An intra-aortic balloon pump (IABP) is an effective device for supporting the circulation in the event of acute heart failure. Small IABP devices are strongly needed in medical related fields. The authors have been investigated an IABP device using a linear pulse motor (LPM) in order to actualize a small IABP device to reduce the load of the nurses. This paper discusses the characteristics of the LPM developed by the authors for the IABP drive, and performance evaluation of an LPM-driven IABP.Our investigation revealed as follows; (1) The trial LPM had the volume of 1.3 liters and the mass of 6.3kg. It is capable of reduction the weight of the IABP device. (2) The LPM had a high thrust/volume ratio of 0.88 newtons/mL. (3) The driving characteristics of the LPM-driven IABP was evaluated by means of a mock testing device. The volume of operating balloon was measured with the electrical resistance between two electrodes. The maximum pumping rate of the IABP device was approximately 160 beats/min. The LPM-driven IABP will be possible to apply clinical study as small-sized device from the result of experiment.

Performance Evaluation of a Linear Pulse Motor-Driven Intra-Aortic Balloon Pump

An intra-aortic balloon pump (IABP) is an effective device for supporting circulation in the event of acute heart failure. Small IABP devices are in urgent demand in medical fields. The authors have investigated an IABP device which uses a linear pulse motor (LPM) in order to reduce the device size. This paper discusses the characteristics of the LPM developed by the authors to drive the IABP, and describes the results of evaluation of an LPM-driven IABP. Our investigation revealed the following. (1) The trial LPM was 1.3 L in volume and had a mass of 6.3 kg. Its use will reduce the weight of IABP devices. (2) The LPM has a high thrust/volume ratio of 0.88 N/ml. (3) The driving characteristic of the LPM-driven IABP was evaluated using a mock testing device. The maximum pumping rate of this IABP device is approximately 120 beats/min. As a result, an LPM-driven IABP will be capable of sufficiently high performance to enable clinical use.

リニアパルスモータ駆動式大動脈内バルーンポンプの性能評価

An intra-aortic balloon pump (IABP) is an effective device for supporting the circulation in the event of acute heart failure. Small IABP devices are strongly needed in medical related fields. The authors have investigated an IABP device using a linear pulse motor (LPM) in order to actualize a small IABP device. This paper discusses the characteristics of the LPM developed by the authors for the IABP drive, and its performance evaluation on an LPM driven IABP. Our investigation revealed the following. (1) Our trial LPM is 1.3 liters in volume and 6.3 kg in mass. Its use will reduce the weight of the IABP device. (2) The LPM has a high thrust/volume ratio of 0.88 newtons/ml. (3) The driving characteristic of the LPM-driven IABP was evaluated by using a mock testing device. The maximum pumping rate of this IABP device is approximately 120 beats/min. As a result, an LPM-driven IABP will be capable of sufficiently high performance for clinical use.

Coronary arteriography by the percutaneous transfemoral technique in patients on intraaortic counterpulsation.

Presented are the results of the use of the transfemoral approach for coronary arteriography, as a safe alternative to the brachial approach, in evaluating patients in cardiogenic shock. Five patients, each with an intraaortic balloon pump device in operation, were evaluated. No complications were encountered using the transfemoral approach.