Intraaortic Balloon Pump (IABP)

What is an intraaortic balloon pump (IABP)?

The intraaortic balloon pump (IABP) is a device used in some critically ill people to help the heart pump. This temporary help may make the difference between life and death.

When is an IABP used?

The IABP provides temporary help to a severely weakened heart. It is sometimes used during or after cardiac surgery to help remove the patient from the heart-lung bypass machine. It can also be used to improve blood flow to the heart while you await surgery or angioplasty for severe blockage of the heart arteries or if the heart cannot pump well enough to circulate the blood. It is sometimes used to help the heart of severely ill people who are awaiting a heart transplant.

How does the IABP work?

The IABP is a long tube (catheter) with a collapsed, 8-inch, sausage-shaped plastic balloon at its tip. The catheter is inserted in an artery in your groin. You will be given a shot to numb the area where the tube is inserted, but you will remain awake. You may have some minor discomfort, but the procedure is mostly painless. The doctor directs the tube through the artery and positions it in your aorta, the large blood vessel in the mid-chest. A pump is attached to the hub end of the catheter. The balloon is rapidly inflated and deflated using your own heartbeat as a trigger.

The balloon inflates at the beginning of the resting period of each heartbeat. The inflated balloon raises blood pressure in the aorta while the heart muscle "catches its breath." The higher aortic blood pressure increases blood flow to all the body's organs, particularly to the resting heart muscle through the coronary arteries.

Rapid deflation of the balloon occurs with the start of the next heartbeat. This quickly lowers blood pressure in the aorta and lessens the work of the heart. The result is increased blood flow from the heart at less cost to the heart.

What are the risks and complications of using an IABP?

The IABP, made of various forms of plastic, is a foreign object in the bloodstream. Foreign objects can cause formation of blood clots. The major danger of the IABP is the formation of blood clots around the catheter. Blood thinners (anticoagulants) must be used to prevent the clots. If clots do form, parts of them may break away and float with the bloodstream to block arteries. When the pump is left in for more than a few days, there is risk of infection.

The IABP can be used for weeks. Then, danger of clots in the bloodstream and worsening mechanical problems with the balloon itself require IABP removal. The longer the balloon is in place, the more dangerous it becomes. Because it requires constant attention IABP's are used mainly in intensive care units.

What are the results of IABP?

IABP is reserved for critically ill people, and high death rates continue to occur in this group. The IABP itself is rarely the main cause of death. The disease requiring its use is usually responsible. Though imperfect, an IABP is able to save some critically ill people who would otherwise die.