Indicaciones y contraindicaciones del balón de contrapulsación

Counterpulsations from an intra-aortic balloon pump (IABP) can help maintain vital circulation for a patient in shock or severe heart failure. This can keep the patient alive until definitive therapy can be instituted.

Indications for use of IABP - myocardial ischemia related:

1. heart failure associated with ischemia-related ventricular arrhythmia
2. refractory cardiogenic shock following acute myocardial infarction
3. papillary muscle rupture or rupture of the ventricular septum after myocardial infarction
4. unstable angina unresponsive to medical treatment
5. prophylaxis in a patient undergoing coronary revascularization with very poor left ventricular ejection
6. prophylaxis for a patient undergoing high risk angioplasty

Indications for use of IABP - myocardial function:

(1) refractory cardiogenic shock after cardiac surgery

(2) refractory shock associated with other causes (post-operative, trauma)

(3) presence of a mechanical problem with the heart

(4) heart failure after cardiac transplantation

(5) heart failure associated with viral myocarditis

Contraindications to use of IABP:

(1) aortic valve insufficiency

(2) dissecting aortic aneurysm

(3) traumatic aortic transection

(4) abdominal aortic aneurysm

Contraindications affecting insertion of IABP into femoral artery:

(1) severe atherosclerosis affecting the distal aorta, iliac and/or femoral arteries

(2) recent groin incision

Relative contraindications (poor long term prognosis or high risk complications):

(1) irreversible hepatic, renal or pulmonary failures (except transplant candidate)

(2) massive stroke

(3) incurable malignant disease

(4) severe coagulopathy

(5) sepsis or severe persisting infections

Referencias:

Kallis P. 18.4.3: Intra-aortic balloon counterpulsation. pages 1368-1370. IN: Webb AR, Shapiro MJ, et al (editors). Oxford Textbook of Critical Care. Oxford Medical Publications. 1999.

Pennington DG, Joyce LD, et al. Patient selection. Ann Thorac Surg. 1989; 47: 77-81.

Richenbacher WE. Intraaortic balloon counterpulsation. pages 31-52 (Table 3.1, page 34; Table 3.2, page 35). IN: Richenbacher WE. Mechanical Circulatory Support. Landes Bioscience. 1999.

Wilson RF. Chapter 41: Cardiovascular failure following trauma. pages 906-944 (page 936). IN: Wilson RF, Walt AJ (editors). Management of Trauma, 2nd Edition.Williams & Wilkins. 1996.