Intra-aortic Balloon Pump – Special Devices (ICU and Brain Death Determination)

00:02 This is a large left ventricular assist device, a bedside one.

00:07 These devices actually can be quite small and can actually be basically in the chest with a pack that you carry at your waist and you can go home with them.

00:18 But that's not a common situation.

00:21 The intra-aortic balloon pump as an example of a cardiac assistive device.

00:26 It has a balloon that is placed into the proximal aorta, which inflates during cardiac diastole.

00:32 When the heart is relaxed, the balloon and the left ventricular assist device inflates.

00:41 Disinflation creates increased perfusion pressure in the coronary arteries due to a higher back pressure in the proximal aorta, effectively increasing myocardial blood flow.

00:51 The balloon then deflates during systole, reducing the active load on the heart and allowing it to pump blood forward.

00:57 This kind of device is often used to stabilize patients prior to cardiac surgery, and it can actually be used, as I mentioned earlier, as a bridge to heart transplant.

01:09 And the smaller devices that can be implanted are used temporary as artificial hearts.

01:15 And people can use them for up to several months before they start to have problems with them.

01:22 And this is a diagram of how this device works.

01:25 You can see that the balloon, which is the gray device in the aorta, comes all the way up almost to the heart, just to where the left subclavian artery comes off.

01:38 And it inflates during diastole, increasing the pressure in the blood close to the heart, forcing it into the coronary arteries and improving myocardial oxygenation. And then during cardiac systole, it deflates so that the pressure against which the heart is working is markedly reduced and the oxygen demands of the heart are reduced.

02:00 And sometimes this can result in complete recovery of the heart.

02:06 The ECG is modified and you have to learn how to utilize this device and you have to learn how to set the device to inflate and deflate at the right times.

02:17 If you're off by even just half a second or so, you can cause a lot of problems.

02:22 So it takes highly skilled people to use this thing.