Overview
An intra-aortic balloon pump (IABP) is a device that helps the heart work more efficiently for a short time. It's often used to help with recovery after heart surgery or when the heart is weakened during a heart attack. An IABP is a type of temporary mechanical circulatory support that may only be needed for a few days.
An IABP is made up of a thin, flexible tube called a catheter. At the end of the catheter is a small balloon. The balloon is placed in the main artery that carries blood from the heart to the rest of the body, called the aorta. The catheter is connected to a machine called a console that controls when the balloon inflates and deflates.
The device does not replace the heart or pump blood on its own. Instead, the balloon works with your heartbeat. It inflates when the heart relaxes between beats and deflates just before the heart pumps again. This pattern is called counterpulsation.
When the balloon inflates, it increases pressure in the aorta. This helps more blood flow to the heart muscle. When the balloon deflates, it lowers pressure in the aorta. This makes it easier for the heart's main pumping chamber, called the left ventricle, to pump blood to the rest of the body. Together, these actions can improve blood flow and reduce the stress on your heart.
The procedure to place an IABP may be done by healthcare professionals in a cardiac catheterization lab, an intensive care unit or an operating room, depending on the situation. Other heart-support devices can provide more circulatory support or support the heart in different ways than an IABP. Your healthcare team considers the cause of your heart condition and how much support is needed when choosing a device.
Why it's done
An intra-aortic balloon pump may be used when the heart needs temporary help pumping enough blood to the body. It can reduce the heart's workload and support blood flow while your healthcare team treats the condition affecting the heart or plans another treatment.
Your healthcare professional may recommend an IABP in certain situations, including:
- Cardiogenic shock. This serious condition happens when the heart can't pump enough blood to meet the body's needs. An IABP may be an option for some people with cardiogenic shock, depending on the cause. Routine use of this device isn't recommended for everyone with cardiogenic shock.
- Certain heart attack complications. An IABP may be used when a heart attack causes serious damage to the heart, such as a hole between the lower heart chambers or a heart valve that suddenly leaks badly. The pump can help support the heart for a short time while your care team plans other treatment.
- Severe heart failure. An IABP may give temporary support for some people with heart failure and very low blood flow. It also may serve as a bridge to another treatment, such as a ventricular assist device (VAD) or heart transplant.
- Ongoing reduced blood flow to the heart. Sometimes an IABP may be used when reduced blood flow to the heart continues despite other treatment and another procedure or surgery can't be done right away.
- Certain heart procedures or heart surgery. An IABP may provide temporary support for some people during a high-risk heart procedure or when the heart isn't pumping well enough after heart surgery.
- Serious heart rhythm conditions. An IABP may sometimes provide temporary support when a dangerous heart rhythm affects blood flow and other treatment is being planned.
An IABP does not give as much circulatory support as some other devices. The healthcare team considers the cause of the heart condition, the amount and type of support needed, and the person's overall health when deciding which device to use.
Risks
Possible risks and complications of an intra-aortic balloon pump (IABP) include:
- Bleeding. Any surgery can increase the risk of bleeding. Bleeding can happen where the catheter enters an artery or elsewhere in the body. Because people with an IABP often receive blood-thinning medicines to help prevent blood clots, the risk of bleeding may be higher.
- Blood clots. Clots can form and block blood flow to a limb or another part of the body.
- Stroke. A stroke can occur during IABP treatment.
- Infection. An infection can develop where the catheter enters the body.
- Device issues. Sometimes the balloon can move out of position, leak or rupture. The catheter also can kink or stop working properly.
- Reduced blood flow. The catheter or balloon can block or reduce blood flow through an artery. When the catheter is placed through an artery in the groin, reduced blood flow to the leg is an important concern.
- Damage to an artery. Inserting or using the catheter can injure an artery. Rarely, this can include a tear in the wall of the aorta, called an aortic dissection.
Your healthcare team will watch closely for any issues while the IABP is in place. Team members will check blood flow in the arm or leg where the catheter was inserted, monitor blood test results, and make sure the catheter and balloon stay in the correct position.
How you prepare
Because people who need an IABP may be seriously ill, the device sometimes needs to be placed quickly. The procedure may be done in a cardiac catheterization lab or, when needed, at the bedside in a cardiac intensive care unit.
Before placing an intra-aortic balloon pump, the healthcare team considers your heart condition, blood flow and other health conditions to decide whether this device is appropriate for you. In some situations, an IABP may not be safe. For example, it may not be used if you have a leaky aortic valve, called aortic valve regurgitation, or an issue with the aorta, such as a bulge, called an aneurysm or a tear, called a dissection. An IABP also may not be safe if you have an uncontrolled bloodstream infection, a bleeding disorder or serious blockages in the arteries of the leg, known as peripheral artery disease.
What you can expect
Before the procedure
The care team may assess the artery for conditions that could make inserting the balloon pump difficult or unsafe, such as severe plaque buildup, narrowing, blockage or a tear in the artery. The balloon catheter also is selected to fit your body size.
The healthcare team decides where to insert the catheter. Most often, it is inserted through a large artery in the groin. In some situations, an artery near the shoulder may be used instead.
During the procedure
An intra-aortic balloon pump (IABP) procedure is usually performed in a cardiac catheterization lab. Sometimes it can be done at the bedside in a cardiac intensive care unit (ICU). Imaging tests may be used to help guide placement.
Most often, the device is inserted through a large artery at the top of the leg, called the femoral artery. A healthcare professional places a thin wire into the artery and then guides the balloon catheter over the wire into the body's main artery, called the aorta. In some people, an artery near the shoulder or arm may be used instead.
The balloon is positioned so it can help the heart without blocking blood flow to important arteries.
After the catheter is in place, it is connected to a machine called a console. The console moves helium gas in and out of the balloon, so it inflates and deflates with each heartbeat. The catheter also allows the healthcare team to monitor blood pressure in the aorta.
The healthcare team checks that the catheter is in the correct position. The team may use X-rays or ultrasound imaging to confirm placement. On a chest X-ray, a marker on the tip of the catheter helps the team check its location.
After the procedure
After the IABP is placed, it helps support your heart while your healthcare team treats the condition that made it necessary to have the IABP. The healthcare team monitors you closely, usually in an ICU.
How the IABP is monitored
Your healthcare team continuously monitors your heart rhythm and blood pressure. The monitor displays a pattern called a waveform, which helps the team make sure the balloon is inflating and deflating at the right time.
Correct timing is important. If the balloon inflates or deflates too early or too late, it may not help the heart as much and could make the heart work harder. The healthcare team can adjust the timing when needed.
The team also looks at changes in blood pressure and other information on the monitor to see how well the device is working. The amount of support the pump provides can vary based on factors such as your heart rhythm, blood pressure and the position of the balloon.
Care while the IABP is in place
While the IABP is in place, your healthcare team regularly checks the catheter, the pump and your blood circulation. Team members pay close attention to blood flow in the arm or leg where the catheter was inserted and watch for bleeding or other complications.
X-rays or other imaging tests may be used to make sure the catheter stays in the correct position. Blood tests also may be done to check your blood cells, platelets and kidney function.
The length of time an IABP is needed varies from person to person. It may be used until the heart recovers or until another treatment can be performed. For some people, support is needed for only a few days. Others may need it for a longer period.
IABP removal
As your condition improves, your healthcare team may gradually reduce the amount of support from the IABP. This process is called weaning.
If your heart and circulation remain stable with less support, the device can be removed. In some cases, it may need to be removed sooner if a serious complication occurs.
Results
The goal of an intra-aortic balloon pump (IABP) is to temporarily help your heart pump blood and improve blood flow throughout your body. It supports your heart while your healthcare team treats the condition affecting your heart or plans another treatment. An IABP is a short-term support device. The underlying condition still needs treatment.
Your healthcare team will closely monitor how your heart and circulation respond to the IABP. Signs that the pump is helping may include improved blood pressure, better blood flow and less strain on your heart. Each person's response is different and depends on the heart condition being treated.
If your heart recovers and your condition becomes stable, the device can be removed. In some cases, the pump is used until another treatment can be done, such as heart surgery, placement of a ventricular assist device (VAD) or a heart transplant.
If the IABP does not provide enough support, your healthcare team may recommend other treatments or a device that can provide more help for your heart and circulation.