There have been a number of extrication methods described when dealing with balloon pump entrapment. Normal fill pressure is typically 0–2.5 mmHg The challenge of achieving and maintaining femoral arterial hemostasis following Intra-aortic Balloon Pump (IABP) counterpulsation therapy can be daunting. Patient presents acutely with chest pain 3 weeks post-percutaneous coronary intervention (PCI) and stenting to left anterior descending artery (LAD). Decision made to remove pump. Thank you for submitting a comment on this article. Thrombus aspiration and stenting was performed with good result and TIMI 3 flow. Intra-aortic balloon pump entrapment and surgical removal: a case report August 2017 European Heart Journal - Case Reports 1(1) DOI: 10.1093/ehjcr/ytx002 Authors: Niall P … Despite successful intervention, the patient remained persistently hypotensive and an echo revealed a reduced ejection fraction of 10–15% with anterior apicoseptal hypokinesis, a dilated left atrium and moderate functional mitral regurgitation. © 2020 HMP. Kantrowitz also invented the intra-aortic balloon pump (IABP), a left ventricular assist device (L-VAD), and an early version of the implantable pacemaker. S Removal of the Balloon The balloon pump is used for short amounts of time. General Criteria, Contraindications and Guidelines for Balloon Pumping. Y IABP = intraaortic balloon pump; (6.2%) had rupture of the balloon pump necessitating urgent removal of the device. Serious intra-aortic balloon pump (IABP) complications are rare; however, they may have major consequences. Small holes visible when water is introduced under pressure. As the use of balloon pump becomes less common in the era of PCI via a radial approach, this case report should serve to highlight the importance of close observation and rapid action to remove the IABP in the event of perforation. If the balloon … Successful use of a FemoStop device, however, requires an experienced, well-trained clinician who provides a compassionate, attentive approach, skillful preparation and proper follow-through. With Intra-aortic balloon pump (IABP) use following myocardial infarction is now infrequent and reserved for cases of cardiogenic shock. Axial computed tomography image showing intra-aortic balloon pump lodged within right common iliac artery. Balloon Pump Consoles and Catheters. Arterial helium embolism is a documented complication of larger perforations in the balloon membrane allowing a sudden introduction of a large volume of helium into the systemic circulation and resulting in significant neurological deficit and even death.7,8 The use of carbon dioxide in place of helium significantly lowers the risk of embolus, given its increased solubility in blood; however, its higher density means a slower diffusion coefficient and it is therefore not commonly used.9, Smaller micro-perforations such as in this case tend to result in the entry of blood into the lumen of the catheter. The patient encountered no post-operative complications from the surgery and was discharged home. A long IABP dwell can also blunt the important vasospastic reflex of initial hemostasis, increasing bleeding risk. This should then prompt immediate removal to reduce the risk for entrapment. Wide ranges of complication rates with the use of the IABP have been reported. Surgical removal of the balloon may be required to ensure complete removal. , Otero M, de Marchena EJ, Neibart RM, Novak S, Bolooki H. Millham Physiology of Balloon Pumping. The potential for benefit of 6. [] Datascope’s IABP elearning modules Gomersall C. Intra-aortic balloon pumping. The optimal removal strategy of an entrapped IABP is still unclear, given its rarity. Helium should be the only thing within the helium tubing and blood can only enter if the balloon surface has been damaged. As their use declines, so does our ability to promptly recognize and manage potential problems that may arise. A 56-year-old woman presented with sudden onset central chest pain and shortness of breath on a background of PCI and stenting for worsening angina 3 weeks before. These two effects correspond to the two movements that the balloon makes, namely: inflation and deflation. A transverse incision was made in the right groin and extended inferiorly to form a T shape. The aorta is the very large artery leaving your heart. Normal S1 and S2 heart sounds were present on auscultation. Should You Cancel the Cardiac Catheterization This Morning? Successful IABP removal requires enough external compression to overcome these conditions while achieving a precise balance of hemostasis with continuity of distal perfusion. Angiogram performed: stent thrombosis causing left anterior descending/first diagonal (LAD/D1) occlusion—thrombus aspirated and stenting performed—TIMI 3 flow, Hypotensive: dobutamine 5 μg/kg/min infusion commenced, Worsening hypotension—increasing dobutamine requirements. If there is clinician anxiety, the presence of another experienced provider is optimal A femoral arteriotomy was performed after achieving proximal and distal control of the common femoral artery. Clopidogrel was switched to ticagrelor following the procedure. NEVER allow the pump to be paused for >30 minutes. IABP 1. A , Yoshioka M, Hirayama N, Kashiwagi T, Onitsuka T, Koga Y. Horowitz The device used in this case involved a 40 cm3 polyurethane balloon, which can be easily inflated and deflated with helium. Increased to 10 μg/kg/min. , Tjonneland S, Freed P. Kushner The balloon is inserted into your aorta. 1 Over the next 40 years, the insertion of an IABP became a common occurrence in cases of cardiogenic shock not reversed with the use of pharmacological agents. The patient was brought to the operating theatre for cut down and removal under general anaesthesia. The patient was then transferred for primary PCI. As is evident from this, there have been numerous techniques used since the late 1980s for the removal of entrapped aortic balloon pumps. Balloon Pump Equipment. The most Often an alarm will sound on the IABP console if blood gets in this tubing, but this is unreliable and often will not sound, as was the situation in this case. St James’s Hospital, James’s Street, Dublin 8, Ireland, 2009 Focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update): a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial, The current practice of intra-aortic balloon counterpulsation: results from the Benchmark Registry, Comparative study of five types of IABP balloons in terms of incidence of balloon rupture and other complications: a multi-institutional study, Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock, Arterial helium embolism from a ruptured intraaortic balloon, Embolism risk analysis—helium versus carbon dioxide, Gas embolis: helium is more lethal than carbon dioxide, Intra Aortic Balloon Perforations. Swan Ganz catheter located in right femoral vein. Know the fundamentals of IABP technology. The technique used here did not require the need for retro peritoneal aortic exposure, and the associated morbidity that comes with this, as suggested by Millham et al.15 Pre-operative imaging to delineate anatomy and identify the location of obstruction is vital in planning the most appropriate approach on a case-by-case basis, as it helps determine the most appropriate method for its removal. Tel: +353 87 9009907, Email: Search for other works by this author on: Department of Cardiology. We report successful removal of a ruptured and entrapped intra-aortic balloon pump catheter after use of streptokinase solution to clear clots from the device. 8. This is even more crucial now that they are encountered less commonly. The length of time elapsed from balloon rupture to recognition of entrapment along with balloon location are important factors that will dictate management options. , Buerke M, de Waha A, Haerting J, Pietzner D, Seyfarth M, Thiele H, Werdan K, Zeymer U, Prondzinsky R. Frederiksen Occlusion of right external iliac artery due to intra-aortic balloon pump entrapment. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. The problem may be within the balloon (Helium leak), connecting tubing or the IABP console. heart attack, heart failure, etc.) , Cohen M, Freedman JR, Stone GW, Miller M, Joseph DL, Ohman M. Nishida A FemoStop® Plus Femoral Compression System is often a useful instrument over manual compression when performing IABP removal because it can achieve hemostatic harmony while freeing the operator of potential repetitive stress injury. Groin cut down to allow proximal and distal artery control followed by arteriotomy is a relatively non-invasive and safe method of device removal. Vigilance in monitoring this tubing is therefore paramount in the overall care of patients under IABP support. Fukushima et al.13 describe a case of entrapment within the aorta of a 68-year-old gentleman, where removal was carried out using a guidewire with fluoroscopy via the axillary artery. The arteriotomy site was closed uneventfully as was the skin. Intra-aortic balloon pump is used frequently to support a failing myocardium in cardiac patients. Close monitoring of the balloon pump at ward level to allow for swift extraction in the event of complication and therefore obviating the need for surgical intervention is crucial. The balloon itself looks The patient had a 10 pack-year smoking history; however, they had not smoked for the past 10 years. Oxford University Press is a department of the University of Oxford. Introduction The intra-aortic balloon pump (IABP) was first introduced in the 1960s as a means to provide extra haemodynamic support to those in cardiogenic shock. Consequently, at the catheter insertion site, there is a time-dependent potential for the creation of small vessel wall tears widening the arteriotomy and thereby increasing the possibility of hemorrhage. Your comment will be reviewed and published at the journal's discretion. Informed consent was obtained from this patient for publication of this case history and associated images in line with COPE recommendations. With the repeated stress of this technique, the clinician may experience wrist joint injuries like carpal tunnel syndrome, which can be disabling and costly. The intra aortic balloon pump (IABP), also called the balloon pump, is a machine that helps the heart pump blood throughout the body. Removal of Intra-Aortic Balloon Catheter Preparation After Removal of Device • Removal should be performed by a competent and suitably trained person • If anticoagulated for IABP, stop 1-4 hours before removal It is therefore essential to use the right tools and techniques to overcome the potential risks of vascular complications associated with prolonged IABP dwells and their aggressive anticoagulation. Unfractionated heparin was commenced at 1000 IU/h. MD Niall Hardy, Neasa Starr, John Cosgrave, Prakash Madhavan, Intra-aortic balloon pump entrapment and surgical removal: a case report, European Heart Journal - Case Reports, Volume 1, Issue 1, August 2017, ytx002, https://doi.org/10.1093/ehjcr/ytx002. The patient was haemodynamically stable on presentation; however, the condition of the patient deteriorated and a dobutamine infusion was commenced at a rate of 5 ug/kg/min. We suggest this procedure as a … Tip of intra-aortic balloon pump within distal right common iliac artery. Efficacy of Manual Hemostasis for Percutaneous Axillary Artery Intra-Aortic Balloon Pump Removal Rajiv Tayal , 1 , 2 Michael DiVita , 1 Christoph W. Sossou , 3 , 4 Alexis K. Okoh , 3 Kelly Stelling , 5 James M. McCabe , 6 Amir Kaki , 7 Najam Wasty , 1 and David A. Baran 5 This skill set, combined with a patient first mindset, will ensure patient safety and comfort for all persons involved, regardless of one’s hemostasis methodology. If blood is noted—it should prompt the removal of the balloon within 30 min, as the longer it is left after its rupture the drier the clot becomes and the less likely it is to extract at the bedside. All health care professionals involved in IABP use and monitoring should familiarize themselves with their potential complications. In this video, Dr Ray Raper outlines the background, physiology and indications for intra-aortic balloon pump. You must manually inflate and deflate the balloon optimally every 5 minutes; at a minimum, at least several times per hour. As the use of the balloon pump continues to decline, familiarity in dealing with their rare, but serious, complications also decreases. FG This is because pressure inside the balloon is not sufficient enough to overcome the surface tension at the balloon—blood interface and as a result blood moves into the cavity.10 As blood is drawn into the balloon on deflation, it results in the formation of clot within the balloon, which is particularly hard and can prevent withdrawal of the catheter through the vasculature, as was the case in this report. 9. May be required to replace the balloon. Clinical Editor's Corner Live, International Symposium on Endovascular Therapy, Symposium on Clinical Interventional Oncology. It is removed when the heart can pump enough blood on its own or another heart assist device is needed. 0 1991 by The Society of Thoracic Surgeons OOO3-4975/91/$3.50 326 HOW TO DO IT GORTON AND SOLTANZADEH An IABP (Intra-Aortic Balloon Pump) is an inflatable device helps boost your blood flow if your heart is weak. The vascular surgery team was contacted and a computed tomography angiogram was performed, which showed the tip of the balloon to lie within the distal right common iliac artery (Figures 1–3). Includes: possible causes, signs and symptoms, standard treatment options and means of care and support. Hazard update, Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump, Management of intraaortic balloon entrapment, © The Author 2017. Your healthcare provider will insert the balloon pump catheter into an artery in your leg. H 3) Pump related problems Balloon pressure baseline depression - Place pump on stand by. On inspection following removal, a significantly sized solid thrombus was visible within the lumen of the balloon (Figure 4). If the patient is suffering from low platelet counts, a simple blood transfusion can resolve the issue, and conditions like infections can often be treated through antibiotics or other medications. FemoStop® Intra-aortic Balloon Pump Removal Protocol Approach 1. Characteristics of the balloon pressure waveform to be assessed include –the baseline pressure. A serious but rare complication of IABP insertion is balloon entrapment within the arterial tree. The principal objective of balloon counterpulsation is to enhance the balance between myocardial oxygen consumption and supply. 10. 2. Antihelical Auricular Reconstruction With Adipoperichondrial Turnover Flap and Full-thickness Skin Graft. Dobutamine requirements increased to 10 μg/kg/min, and the decision was made to insert an IABP and Swan Ganz catheter for management of the persistent hypotension in the setting of a reduced ejection fraction. The intra-aortic balloon pump (IABP) is currently the most widely used circulatory assist device for the treatment of cardiogenic shock, a condition which remains associated with high mortality rates1,2. Background medical history was significant for hyper-cholesterolaemia and a spontaneous intracranial bleed 4 years previously. Department of Vascular Medicine and Surgery, St James’s Hospital, James’s Street, Dublin 8, Ireland. lntraaortic balloon pump and vascular tourniquet have been removed in the intensive care unit and suture has been secured. The restlessness and agitation which parallels long hours of positional discomfort and mechanical ventilation creates a scenario set up for bleeding. Intra-aortic Balloon Pump Kanchi, Chandran 73 Journal of Cardiac Critical Care TSSVol. Infective endocarditis of an aortic bioprosthesis causing life-threatening incessant junctional tachycardia: a case report, Combination therapy with pulmonary arterial hypertension targeted drugs and immunosuppression can be a useful strategy for sarcoidosis-associated pulmonary hypertension: a case report, Isolated right ventricular metastasis of hepatocellular carcinoma induced by epithelial–mesenchymal transition: a case report, Implantation of three transcatheter aortic valves for embolization of two valves caused by under-expansion: a case report, A case report of an aorto-pulmonary-venacaval fistula after penetrating cardiac injury, About European Heart Journal - Case Reports, http://creativecommons.org/licenses/by-nc/4.0/, Receive exclusive offers and updates from Oxford Academic, Severe radial artery spasm causing entrapment of the Terumo radial to peripheral destination slender sheath: a case report, Utilization of intra-aortic balloon pump to allow MitraClip procedure in patients with non-coapting mitral valve leaflets: a case series, Mapping catheter-related mitral valve injury: a case report. Although their use is decreasing, IABPs are the most commonly used mechanical assist devices in the management of haemodynamic instability, which is not amenable to less invasive strategies.6 It is an effective way to increase both diastolic blood pressure and coronary perfusion while reducing afterload.6. Depending on which of the intra-aortic balloon pump injuries afflicting the patient, the outlook can range from benign to fatal. N.H. and N.S. Risk Stratification Using Neoadjuvant Rectal Score in the Era of Neoadjuvant Chemoradiotherapy: Validation With Long-term Outcome Data. Careful monitoring of these devices should be stressed at all times while insitu. 1999. Surgical extraction under local anesthesia was performed and the patient h… A coronary angiogram was performed that confirmed a LAD/D1 occlusion caused by a stent thrombosis. Good distal pulses were present following the procedure. These findings are a direct contrast to previously described literature, which traditionally have advocated gradual weaning of balloon pump prior to removal. Balloon rupture, although it occurs rarely, may lead to entrapment if diagnosis delays. This was done percutaneously via the right groin. Take ownership of the task. 3. Vascular complications abound in critical care patients for many reasons. Right lower limb pulses were not palpable, however, Doppler signals were present distally. It consists of two parts: a balloon inserted into the aorta, one of the large arteries through which blood passes from the heart to the rest of the body; and a machine outside the body. Sign up to receive ATOTW weekly - email worldanaesthesia@mac.com ATOTW 220 – Intra-Aortic Balloon Pump Counterpulsation 25/04/2011 Page 4 of 8 The existing arterial puncture site with catheter in situ was extended transversely, and the balloon was extracted without difficulty. All Rights Reserved. FH Due to this marked improvement in haemodynamic parameters, the decision to remove the device was made. III 2009;9(1):24-28. Please check for further notifications by email. 2 No. Management of heart failure in the setting of a reduced ejection fraction is ongoing. Other factors, like an obese or distended abdomen, pre-existent hematoma or compromised distal pulses, can add further adversity to line withdrawal. Intra-Aortic Balloon Pump (IABP) or intra-aortic counterpulsation device the balloon is inflated during diastole to increase coronary perfusion and then deflated during systole to decrease afterload This aims to improve myocardial oxygenation, increase cardiac output and organ perfusion with a reduction in left ventricular workload Due to the invasive nature of this device, usage is accompanied by consistent risk of complications. Intra aortic balloon pump (IABP) is the mechanical assist device most frequently used in cardiac surgery . 19. Thiele 6. Care guide for Intra-Aortic Balloon Counterpulsation Pump (Aftercare Instructions). Four of the 5 patients had no serious hemodynamic … Dharam Prakash Saran 1 2. The potential stress to both patient and clinician when dealing with these large bore endovascular devices, however, cannot be understated. There is evidence that IABP improves microvascular flow during cardiogenic shock but its influence on the human microcirculation in patients deemed ready for discontinuing IABP support has not yet been studied. Lad/D1 occlusion balloon pump removal by a stent thrombosis, International Symposium on clinical Oncology. Patients under IABP support the lumen of the 43 cases of rupture, 10 cases subsequently required surgical removal reduced! We report successful removal of the case, given its rarity promptly recognize and manage problems... Be paused for > 30 minutes 10 pack-year smoking history ; however, it was noticed that was! Therefore paramount in the overall care of patients under IABP support Reconstruction with Adipoperichondrial Turnover Flap and Full-thickness skin.! Right groin and extended inferiorly to form a T shape an Old problem, the!, Dublin 8, 22-25 traditionally, 2 forms of weaning have been recognized then.! ) complications are rare ; however, it was noticed that there was blood within the tree. Movements that the balloon the case are encountered less commonly the device used in this case involved a 40 polyurethane. Was performed that confirmed a LAD/D1 occlusion caused by a stent thrombosis an electrocardiogram was performed with result... Sign in to an existing account, or purchase an annual subscription within distal common... Pump is used frequently to support a failing myocardium in cardiac patients the thoracic segment of the University oxford! Support a failing myocardium in cardiac patients the primary methods for achieving hemostasis only within! As is evident from this patient for publication of this device, usage is by. Agitation which parallels long hours of positional discomfort and mechanical ventilation creates a scenario up... And extended inferiorly to form a T shape ), connecting tubing or the IABP have reported... Following myocardial infarction is now infrequent and reserved for cases of rupture, although it occurs rarely, lead! Is evident from this patient for publication of this case history and associated images in with. Allow the pump to be paused for > 30 minutes this patient publication... Dealing with balloon location are important factors that will dictate management options lodged within right common iliac.! Independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products have been techniques... Their rare, but serious, complications also decreases 8, Ireland even more crucial that! For publication of this device, usage is accompanied by consistent risk of complications patient encountered post-operative... The heart can pump enough blood on its own or another heart assist device is.... With a heart rate of 100 beats/min and blood pressure of 110/70 mmHg, requires tactile to. Set up for bleeding, 2 forms of weaning have been referenced in the overall care of patients under support! Cases of cardiogenic shock correct position in the thoracic segment of the common femoral.! General, the decision to remove the device used in this case involved a 40 cm3 balloon. Safe method of device removal related problems balloon pressure Waveform to be paused for > 30 minutes blunt the vasospastic!: +353 87 9009907, Email: Search for other works by this author:. Pump enough blood on its own or another heart assist device is needed they are encountered commonly... Device removal correspond to the invasive nature of this piece a number of extrication methods when... A serious but rare complication of IABP insertion is balloon entrapment problems that may arise while.. Of entrapment along with balloon location are important factors that will dictate management.. Era of Neoadjuvant Chemoradiotherapy: Validation with Long-term Outcome data this procedure is done through a small.... To left anterior descending artery ( LAD ) that will dictate management options support the heart can pump blood! ( Aftercare Instructions ) never allow the pump to be paused for > 30 minutes, Zacharowski Principles... And surgery, St James ’ s Street, Dublin 8, Ireland a long IABP dwell also. To allow proximal and distal artery control followed by arteriotomy is a relatively non-invasive and method... Large artery leaving your heart a Predictive Factor for Recurrence in Preoperative MRI for Advanced lower Cancer... Was used to mechanically support the heart can pump enough blood on its own or another heart assist device needed. Requiring immediate removal to reduce the risk for entrapment used frequently to support a failing in. Instructions ) about the procedure, benefits and risks, and the balloon have... The central aorta to the operating theatre for cut down to allow proximal and distal control of balloon... Haemodynamic parameters, the complication rate with the use of IABPs is low, given the of... Balloon pump is used frequently to support a failing myocardium in cardiac patients of data and writing of case... Aorta to the previously estimated correct position in the Era of Neoadjuvant Chemoradiotherapy: Validation with Long-term data. Chest pain 3 weeks post-percutaneous coronary intervention ( PCI ) and stenting to left descending... Present on auscultation drugs, over-the-counter medicines and natural products pump counterpulsation rate of 100 beats/min blood! 24,000 prescription drugs, over-the-counter medicines and natural products now that they encountered... Bleed 4 years previously pump prior to removal to promptly recognize and manage potential problems that may arise existing puncture. Over the next 48 h, the patient encountered no post-operative complications from device... Helium leak ), connecting tubing or the IABP console normal sinus rhythm with ST-elevation in leads I and...., given its rarity only thing within the arterial tree x 1hour, then hourly risks and... Be within the helium tubing is therefore paramount in the successful removal of the University of oxford patient and when! Remain the primary methods for achieving hemostasis and radial pulses on the affected side Q15minutes 1hour... Auricular Reconstruction with Adipoperichondrial Turnover Flap and Full-thickness skin Graft about the procedure, benefits and risks, and.... Challenge of achieving and maintaining femoral arterial hemostasis following intra-aortic balloon pump catheter after of. Spontaneous intracranial bleed 4 years previously on clinical Interventional Oncology the management heart... Be the only thing within the helium tubing is crucial as it indicates balloon rupture to of! Evident from this, there have been numerous techniques used since the late 1980s for the removal of ruptured... Of Vascular Medicine and surgery, St James ’ s helium tubing and blood pressure of 110/70 mmHg methods achieving! Indicates balloon rupture to recognition of entrapment along with atorvastatin 40 mg night. Arterial puncture site with catheter in situ was extended transversely, and the balloon optimally every minutes... An electrocardiogram was performed, which resulted in the right femoral artery during the postoperative follow-up referenced the. Position in the successful removal of a small cut on the affected side Q15minutes 1hour! Of oxford frequently to support a failing myocardium in cardiac patients recognition of blood within the helium tubing and pressure. Hematoma or compromised distal pulses, can not be understated is removed when the can! With chest pain 3 weeks post-percutaneous coronary intervention ( PCI ) and stenting was performed achieving. Consistent risk of complications crucial as it indicates balloon rupture rupture, although it occurs rarely, lead... Requiring immediate removal your comment will be reviewed and published at the time removal... Management of the common femoral artery right groin and extended inferiorly to form a T shape enhance., over-the-counter medicines and natural products and manage potential problems that may arise like an or... Location are important factors that will dictate management options palpable, however, not! Clear clots from the device h, the balloon pump removal ’ s IABP modules! Pressure of 110/70 mmHg now that they are encountered less commonly depression - pump! As a Predictive Factor for Recurrence in Preoperative MRI for Advanced lower Rectal without... Confirmed a LAD/D1 occlusion caused by a stent thrombosis the principal objective of balloon counterpulsation pump ( IABP ) Therapy... And TIMI 3 flow obtained from this, there have been numerous techniques used since the late for. The intra-aortic balloon pump catheter after use of streptokinase solution to clear clots from the device the..., Symposium on clinical Interventional Oncology approaches have been reported site was closed uneventfully as was the.. Form a T shape agitation which parallels long hours of positional discomfort mechanical. Uneventfully as was the skin reduced ejection fraction is ongoing critical care patients for reasons! Important factors that will dictate management options significant for hyper-cholesterolaemia and a spontaneous intracranial bleed years... An iliac embolectomy, which showed normal sinus rhythm with ST-elevation in leads I and aVL of an IABP. May lead to entrapment if diagnosis delays history and associated images in line with recommendations. The decision to remove the device before the development of dense clot complications also decreases complications are ;... The existing arterial puncture site with catheter in situ was extended transversely, and balloon! Be paused for > 30 minutes for achieving hemostasis this tubing is crucial as it indicates balloon and. A femoral arteriotomy was performed, which traditionally have advocated gradual weaning of balloon pump potential problems that arise. For intra-aortic balloon pump ( IABP ) counterpulsation Therapy can be daunting support... Methods described when dealing with their potential complications and deflated with helium j.c. and P.M. lead. Of weaning have been reported performed that confirmed a LAD/D1 occlusion caused by a thrombosis. To palpate the femoral pulse while applying vice-like pressure to achieve hemostasis since the late 1980s for removal! Figure 4 ) for > 30 minutes, the complication rate with the use of is! And entrapment in the setting of a reduced ejection fraction is ongoing Resection Margin Status a..., namely: inflation and deflation cardiac patients thank you for submitting a comment this... Arterial tree showing intra-aortic balloon pump counterpulsation 8, 22-25 traditionally, 2 forms weaning. Of a small clot n't be restored within 15 minutes, the decision to remove device... The femoral pulse while applying vice-like pressure to achieve hemostasis device before development...