Mobilizing pre-heart-transplant patients with a percutaneously placed axillary-subclavian intraaortic balloon pump: A retrospective study

Abstract

The intraaortic balloon pump (IABP) is a treatment for end-stage heart failure patients not responsive to pharmacological therapy pre heart transplantation. An alternative approach-the percutaneously placed axillary-subclavian intraaortic balloon pump (PAxIABP) developed by cardiologists in our hospital enable patients to be mobilized while awaiting transplant versus the traditional bedrest in the femoral approach. Our objective is to determine if PAxIABP therapy enable pre-heart-transplant patients to safely mobilize. A retrospective study of pre-heart-transplant PAxIABP patients in the Coronary Intensive Care Unit (CICU) from 2007 to 2013 (n = 45; 35 men, 10 women) was conducted to determine mobility. Data are presented as mean (standard deviation) for continuous variables and number (percentage) for categorical variables. Patients were mobilized at 1.39 (± 1.41) days after PAxIABP insertion. The number of times mobilized per day was 1.79 (± 2). Transplant waiting time was 24.98 (± 25.03) days. Thirty-seven patients (82%) were transplanted. Two patients had a left ventricular assist device (LVAD) inserted and later transplanted. Six patients died before receiving a heart transplant, patients were 100% mobile. Complication rates: 4% bleeding; 7% ischemic complications; 2% IABP-related infection. Pre-heart-transplant patients receiving PAxIABP therapy can be safely mobilized. Nursing care protocols were developed to safely take care of this patient population. PAxIABP can be utilized for other procedures requiring long IABP therapy.

Using Outcome Measures to Transition Ambulation From Physical Therapy to Nursing for Patients With Mechanical Circulatory Support

“…At our hospital, a multidisciplinary approach to mobility has been used for many years. In a previous retrospective study by Macapagal et al, 15 patients waiting for heart transplants with percutaneously placed axillary or subclavian IABPs were safely mobilized by nursing, consequently, avoiding the complications of prolonged bed rest. The authors in that study used Functional Independence Measure (FIM) scores as their functional outcome measure and only studied patients with IABPs.…”

“…However, decision-making varies from therapist to therapist without using objective data for an informed decision-making process. Nevertheless, a study from Macapagal et al15 discussed the nursing role in ambulating patients with an IABP. The study described the use of new nursing protocol, staff training, and intensive interdisciplinary collaboration between physical therapists and nursing staff.…”

Efeitos do Exercício em Choque Cardiogênico e Balão Intra-Aórtico: Um Relato de Caso

“…Entretanto, novas abordagens relacionadas a um dispositivo externo temporário poderiam ser colocadas na artéria subclávia, na tentativa de mobilizar precocemente os pacientes com ICD. Nessa linha, Macapagal et al 9 mostram que um paciente pré-transplante cardíaco com balão intra-aórtico inserido na artéria subclávia axilar de forma percutânea pode ser mobilizado com segurança. O estudo constatou que o balão intra-aórtico subclávio axilar permitiu que os pacientes fossem mobilizados com segurança enquanto aguardavam o transplante, com os pacientes sendo mobilizados 1,39 (±1,41) dia após a inserção, em vez de três dias como no estudo de Chen et al 8 Nossos resultados corroboram os de Macapagal et al 9 e demonstram que o balão aórtico inserido na artéria subclávia é viável e proporciona uma mobilização muito precoce, evitando, assim, as complicações do repouso prolongado no leito, em comparação com o repouso absoluto no leito para pacientes que possuem um balão intra-aórtico femoral tradicional.…”

Use of the Impella device in ambulatory heart failure and pre-heart transplant patients - one medical center’s experience

“…RNs track patient ambulation in the EMR with a chart that calculates distances walked by the patient relative to the hallway distances available. [23]…”