Ultrasound-guided insertion of intra-aortic balloon counterpulsation in intensive care: description of the technique

Abstract

Intra-aortic balloon counterpulsation (IAoBC) is a mechanical circulatory support device that has been used for more than 50 years, mainly for cardiogenic shock. Although its effect on mortality is controversial, IAoBC is still used in a wide variety of pre-and postoperative clinical settings in cardiac surgery centers. IAoBC has a complication rate of approximately 30%, mostly associated with problems during insertion and malpositioning. Thus, an insertion technique based on the use of ultrasound at the patient's bedside in the intensive care unit (ICU) is proposed.

Bedside intra‐aortic balloon pump insertion in cardiac intensive care unit: A single‐center experience

“…Bedside IABP insertion was performed in the CICU using a standardized approach (Figure 1), with the patient in the supine position, using a sterile technique, under local or general anesthesia, according to the clinical presentation. After ultrasound assessment of the femoral arteries with a high‐frequency (6–15 MHz) linear transducer, vascular access was obtained using ultrasound‐guided common femoral artery puncture, as previously described 6 . Patients in whom femoral access was deemed complex (due to known vascular disease of abdominal aorta, iliac and femoral arteries or severe atherosclerosis of the femoral arteries identified at bedside ultrasound evaluation) were considered unsuitable for bedside IABP insertion, and received CathLab IABP insertion (Table 1).…”

“…Recent data suggest that this device is the most common MCS employed in ADHF‐related CS 4 . IABP features an easy implantation technique and can rapidly be deployed bedside under transthoracic or transesophageal echocardiographic guidance 2,5,6 . This avoids the need for patient transfer to the catheterization laboratory (CathLab) with the inherent risk of destabilization, and makes it an attractive approach in case of unstable hemodynamics.…”