What is intra-aortic balloon pump therapy?

An intra-aortic balloon pump (IABP) is a device that helps your heart pump more blood. You may need it if your heart cannot pump enough blood for your body.

The IABP consists of a thin, flexible tube called a catheter. Attached to the tip of the catheter is a long balloon. This is called an intra-aortic balloon, or IAB. The other end of the catheter attaches to a computer console. This console has a mechanism for inflating and deflating the balloon at the correct time when your heart beats.

Your heart pumps oxygenated blood and nutrients to all parts of your body. Blood leaves the heart through the arteries, the blood vessels that carry oxygenated blood. The outer walls of the heart also contain arteries. These are called the coronary arteries. Through these blood vessels, the heart gets the oxygen and nutrients it needs.

When the heart contracts, it sends blood out to the body. As it relaxes, blood flows into the coronary arteries to bring oxygen to the heart. An IABP allows blood to flow more easily into your coronary arteries. It also helps your heart pump more blood with each contraction.

The balloon is inserted into your aorta. The aorta is the large artery leaving your heart. In many cases, this procedure is done through a small cut on the inside of your upper leg. Your healthcare provider will insert the balloon pump catheter into an artery in your leg. They will then guide it to your aorta.

From there, the IABP can start to do its work. The balloon is set to inflate when the heart relaxes. It pushes blood flow back toward the coronary arteries. They may not have been getting enough blood without the pump. When the heart contracts, the balloon deflates. That lets the heart pump more blood out to the body while using less energy. The device continues to inflate and deflate until it is removed.

An IABP is a short-term treatment. You may need it until your heart condition improves or until you can get a more permanent treatment. Its use is rapidly growing. But it’s not yet available at all medical centers.

Why might I need intra-aortic balloon pump therapy?

IABP therapy is used to treat cardiogenic shock. That’s when your heart can’t pump enough blood to meet the needs of your body.

Some heart problems can cause cardiogenic shock. These include:

• Unstable angina

• Heart attack

• Certain abnormal heart rhythms

• Heart failure

• Heart defects

You may also need an IABP if you have a certain medical procedure. For example, you may need it if you have a percutaneous coronary intervention. This procedure opens a blocked artery in the heart. You also might benefit from an IABP if you have heart surgery.

In some cases, you might not be able to use an IABP, even if your heart cannot pump enough blood. For instance, people with a leaky aortic valve can’t safely use an IABP. Those with aortic aneurysms also can’t benefit from this therapy choice.

What are the risks of intra-aortic balloon pump therapy?

IABP therapy can be very helpful. It can sometimes even be life-saving. But it does have some risks. These include:

• Damage from the lack of blood flow (ischemia)

• Injury to an artery

• Rupture of the balloon

• Incorrect position of the balloon (might cause injury to the kidneys or other problems)

• Low platelet count(might cause excess bleeding because your blood doesn’t clot as well)

• Infection

• Stroke

Your own risks depend on your age and any other health conditions you may have. For instance, a lack of blood flow to your leg may be more likely if you have peripheral vascular disease.

How do I get ready for intra-aortic balloon pump therapy?

Before your procedure, talk with your healthcare provider about all your concerns. You will be asked to sign a form consenting to the procedure. Be certain to ask any questions you have before you sign. They will give you detailed instructions. Be sure to tell your healthcare provider if you are pregnant or think you could be. Also let them know if you have:

• Any other health conditions

• A problem with sedation

• New symptoms, such as a sudden fever

If you smoke, you should try to stop before your procedure. It will help reduce your chance of complications. You should also not eat or drink anything after midnight before the day of your procedure. You may also need to stop taking any medicines. Before and during the treatment, you will likely need to take medicine to help prevent blood clots.

You may need other tests to evaluate your health beforehand. These might include:

• Blood work to check for anemia and infection

• Electrocardiogram to check your heart rhythm

• Chest X-ray to view your heart and lungs

• Echocardiogram to view how well your heart is pumping

• Cardiac catheterization to see how widespread your coronary disease is

What happens during intra-aortic balloon pump therapy?

For this procedure, the balloon-tipped catheter is inserted into a blood vessel and advanced to the heart. This often happens during a heart-related surgery. In an emergency, a medical team may insert it at your bedside or in the cardiac catheterization lab.

Your healthcare provider can tell you exactly what to expect. In general, the procedure has the following steps:

• You’ll first receive some anesthesia. If you are having the insertion during surgery, you may already be under general anesthesia. In that case, you will be asleep and won’t feel anything. In other cases, you may get medicine to help you relax. You will also get numbing medicine at the insertion site.

• During the procedure, your heart rate, blood pressure, and other vital signs will be watched.

• A small cut will be made through an artery in the upper part of your inner thigh/groin. The balloon catheter will be inserted there.

• A surgeon will advance the catheter to a part of the aorta in your chest region. They can see this movement using continuous X-ray imaging (fluoroscopy).

• The balloon will be programmed to inflate when your heart relaxes. It will deflate when your heart contracts

• The end of the catheter will be secured, so it stays in place.

You may feel some chest pain after the procedure. It should go away within minutes of starting the IABP. If you are still having symptoms, you may need further treatment.

Your healthcare provider will watch for complications. You will need to stay in bed afterward and until the IABP is removed. The head of your bed should be slightly raised (elevated). The leg with the catheter insertion should remain straight. That will help keep the balloon from moving out of place. You may also need daily chest X-rays to make sure the device is still in the correct spot. The pump normally makes sounds as it cycles between inflation and deflation.

Tell your provider right away about any new symptoms, such as bleeding from the insertion site. Chest pain might be a sign that the timing of your device needs to be adjusted. A pale color or tingling in your leg may point to reduced blood flow to that region.

What happens after intra-aortic balloon pump therapy?

You may need to stay on the pump for several days. Your healthcare provider will watch you. They may temporarily turn the pump off to see how you respond. Or they may set it to inflate and deflate with only every second or fourth heartbeat. If your heart continues to pump well on its own, you may be ready to stop the IABP therapy. You might also stop the therapy when another intervention becomes available. This might be a donated heart or permanent mechanical assist device.

When it's time to remove the pump, you will likely get medicine to help you relax. Your provider will then remove the catheter and the attached balloon. They will also close up the incision on your leg or apply direct pressure for a few minutes.

Your provider may give you other instructions about what to expect. Follow these carefully to help increase your chances of a positive outcome.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure