Everything You Need to Know About Balloon Pumps

A pump, as the name indicates, is a device that moves fluid or gasses usually mechanically through a medium. This device is commonly used in the hospital setting, and it is called a balloon pump. This pump is an essential lifesaving device in the cardiology unit. The scientific name is the Intra-Aortic balloon pump (IABP), and it helps the heart to pump blood. The insertion of this device is recommended in the case of a cardiogenic shock. With a cardiogenic shock, the heart does not receive enough blood or send enough blood to the rest of the body.  

The balloon pump consists of a small, thin, flexible tube known as a catheter. At the end of the catheter or the tip, as you may call it, is an attached balloon. The opposite end of the catheter is connected to a computer. The computer has a specially designed software in which the inflating and deflating mechanisms are carried out at the proper time in conjunction with the heartbeat. Treatment with this device is the best and most common form of support for a failing heart. It is inflated during diastole and increases coronary perfusion and decreases the afterload during systole. This invention revolutionized the way surgeons and healthcare professionals look at the perspective of the failing heart altogether.

History 

The intra-aortic balloon pump was invented by Dr. Adrian Kantrowitz Wayne of the State University College of Medicine, Sinai Hospital, Detroit, Michigan, in the Journal of the American Medical Association, through an article called "Initial clinical experience with intra-aortic balloon pumping in cardiogenic shock." This article gave the results of the initial trials of the procedure. Following that, published in the American Heart Journal by S. Moulopolous, researched a device that could stabilize a failing heart. 

Between 1967-1969, this device was developed for commercial use by Dr. William Rassman at Cornell Medical center and manufactured by Data Scope Corporation in 1969. The first clinical implants were performed in Brooklyn, New York, at Maimonides Medical Center in October 1967. The age of the ill person was 48 years, gender was female, and she was unresponsive to traditional therapy techniques. The treatment was given for 6 hours consecutively, with the reversal of the cardiogenic shock, and the patient being able to leave the hospital. Before this technique, there was never a 100% chance that a patient could survive the lethal effects of the cardiogenic shock. 

Importance and indications of Intra-aortic balloon pumps 

It is a beneficial medical procedure, and 99% of the time, it is lifesaving if administered at the right time. It is a critical procedure that can save a person's life from suffering very traumatic consequences. We can indicate the usage of an Intra-Aortic balloon pump by checking for symptoms associated with clogged arteries. 

Some symptoms that may occur are:

  • Chest Pain 
  • Shortness of breath
  • Heart palpitations 
  • Weakness or dizziness
  • Nausea or vomiting 
  • Sweating 

Things to do before the procedure

Before the procedure, the healthcare professional must schedule an appointment to discuss all the patient's concerns. The healthcare provider must give the essential guidelines and brief about the surgery to the patient. During the screening, the healthcare provider must check for any other medical conditions, sedation problems, new symptoms such as fever, or if the patient is at a chance of being pregnant. Some things the patient must know to discontinue before the procedure starts are:

  • Smoking
  • Alcohol consumption
  • Drugs/medications that may counteract with the procedure.
  • They must remind them to observe a 12-18 hour fast before their surgery; no liquid or solid food is allowed.

Some tests may also be prescribed, such as: 

  • Blood work (primary) mainly used to assess if the patient is anemic or has any ongoing infection.
  • An electrocardiogram ECG is performed to check the heart rhythm. 
  • A view of the chest and lungs with an X-ray
  • An echocardiogram to check on pumping.

Equipment used in the procedure:

The IABP consists of two parts. 

  1. The large bore catheters, with a balloon attached to the distill tip 
  2. A console that contains a pump that inflates it

Other useful things are listed below.

  • Polyurethane membrane
  • Various catheter sizes, Sheathed or sheath-less

Fiber optic catheters assist in pressure waveform detection. Helium is used to inflate the balloon because of its low density. When raised, it prevents 80-90% of the aorta.

How it works

An Intra-Aortic balloon pump is used to reverse or minimize the effects of a  cardiogenic shock.  There is a vast procedure that must be followed by the Health care practitioner trained for the job—one with an accredited score, who can manage any type of complication or malfunctioning of the device as per standard protocol. This therapy involves inserting the balloon attached to the tip of the catheter into the blood vessels and leading to the heart. The procedure consists of numerous steps.

  • Anesthesia is given to the patient depending on the procedure. If the patient is already under surgery, then the anesthesiologist may provide general anesthesia. If only the Intra-Aortic balloon pump is inserted, the physician may give a medicine to help the patient relax and receive a numbing agent at the insertion site.
  • Medical monitoring devices are used to monitor the patient's vitals. So, it can handle any complication—E.g. Heart rate, Blood pressure, among others. 
  • An incision is made at the upper medial compartment of the thigh, and the catheter is inserted.
  • A certified surgeon performs the procedure and advances the catheter to the patient chest area in the aorta. The continuous x-ray imaging monitors the entire process. 
  • The balloon pump responds to the contract-relax rhythm of the heart. The muscles relax and contract to inflate and deflate it.
  • The catheter is then secured so it cannot move and dislodge. After the procedure, the patient feels pain in the chest. The balloon pump relieves the pain.
  • Some heart problems that can cause cardiogenic shock are unstable angina, myocardial infarction, certain abnormal heart rhythms, its failure, and its defects.
  • It can be used if the patient has a percutaneous coronary intervention, and is undergoing heart surgery.
  • It may be contraindicated if they have a leaky aortic valve or aortic aneurysms. There will be no benefit for patients with these conditions.
  • These can be used for up to 10 days.
  • The duration of this procedure is from 30 minutes to 2 hours, depending on severity, but is generally completed within 60 minutes.
  • The post-operational facility must be well facilitated, and the best interprofessional team is required to take care of the patient. This team must have a cardiologist, ICU specialist, coronary care nurse, and a cardiothoracic surgery unit. Their presence is necessary to provide the best possible integrated care.

Advantages and disadvantages of intra-aortic balloon pumps

Advantages: 

  • Increased circuit blood flow because two access cannulas draw patient blood from more significant veins. 
  • It provides maximal oxygen delivery.
  • Quick and safe to insertion 
  • Easy to secure 

Disadvantages:

  • Occupies three veins
  • Patient remains bedbound 
  • The limited maximal flow rate.

Complications of the use of the Intra-Aortic balloon pump

There are some complications in the use of this device. As with almost all medical procedures, there is a high number of risks associated with it as well. The total amount of complications that may occur equal to 8.1%, Major = 2.7%, and Minor: 5.4%

  • Ischemia can occur, which is the damage from the decreased blood flow to the limb. 
  • An artery can be injured while inserting it into the body.
  • Without being careful about the balloon's position, it may have adverse effects on the kidneys as well as other problems. 
  • Decreased clotting time due to a low platelet count, which can cause excessive bleeding 
  • High chance for stroke to occur
  • Infections can occur at the site of insertion or worst-case scenario they can spread into the body. 
  • Chest pain may occur due to this procedure, which may signify that the device's timing may need checking.
  • Pain or tingling in the leg signifies that the area does not have a supply of blood.  

All these risks depend on the patient's age, any underlying medical problems, past medical history, and family history—these may become factors in triggering new issues. Pre-operative protocols should follow per procedure to keep patients safe from these complications. 

General specifications and Brand market leaders

Many companies manufacture the Intra-Aortic balloon pump, but the most trusted and most popular ones are, 

  • AutoCAT2WAVE® IABP
  • Avantehs
  • GETTING
  • Teleflex

It can cost approximately about $8,614 to have the complete setup in your hospital. Although a costly instrument, it is essential to have in the cardiology unit of any hospital as it is essential for saving a patient's life. 

The procedure itself is also costly if you do not have a health care insurance plan; the entire process can cost anywhere between $1000 to $1500, excluding medications, pre-operative, and post-operative care.

Intra-aortic balloon pump kit includes:

  •  IABP catheters
  •  Arterial dilator 
  •  0.035 Guidewire 
  • Angiographic needle  
  •  Surgical mask, sterile gloves, and gown.
  •  Sterile drapes
  •  Lidocaine 1% sol.
  •  Saline solution 
  •  Scalpel 
  •  2.0 Silk suture 
  •  Angiographic needle 
  •  5cc Syringe 

Conclusion

The invention of a balloon pump was crucial to the medical industry because, without it, the traditional methods of intervention were not trusting. The objective of creating a balloon pump was to save a failing heart by increasing the rate of blood flow to it or the rest of the body. With the conventional procedures, the death rate was higher than the survival rate. The balloon pump invention made it easier for doctors to rely on an intervention that could be used in an emergency and could help the failing heart. This intervention is not only promising but also speedy and cost-effective. It helps the patients to recover faster despite the odds. This lifesaving device is created and marketed for use globally. In this way, many people with heart-related complications are living their lives.