IABP and CPR

Specialties CCU

Published

Ok some may say this is a dumb question, but we got into a heated debate the other day about this. IF a pt on IABP codes, do you turn it off? I obviously said yes but a fellow worker tried to say you could start compressions and have the machine sinc to them. Our CCU only gets a handful of them so we're not experts. Thoughts please.

Specializes in CVICU, ICU, RRT, CVPACU.
Do you have a rationale for this info? Why on earth in a CODE (ie. arrhythmias!) would you go to ECG trigger? That's ridiculous.

I work with the bioengineers who write the triggering programs for the Arrow balloon pumps. They have thousands of hours of experience with IABPs. I am quite certain that I have the most recent recommendation on this. However, I'd be interested to hear the rep's rationale.

I agree, and this directly contradicts the VERY NEW information they are printing in their manuals. The Datascope rep we use says quite the opposite. If you think about it, in ECG mode the timing is based off of the R wave. You are very rarely going to show a good consistant R wave with manual compressions. Pressure mode is going to pick up the change in pressure as the compressions are being performed. Half the time if you have the IABP in ECG trigger in a patient with tachyarrythmias or irregular such as A fib it drives the thing crazy, let alone in irregular abnormal looking compressions on the monitor.

To one of the previous posters above. I wasnt referring to timing the manual inflation to compression. I was simply referring to manual inflation and deflation every few minutes to keep clots form forming on the balloon. Obviously this is not the most desirable option, however it is an option. Your first choice should alway be to use the machines modes.

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Well, it is a pretty simple explanation, it was a misunderstanding on my part.

They were saying that on the newer models, there is no need to manually switch from EKG to pressure triggering, the IABP will do that automatically, if in the auto mode.

Hence, just leave it in EKG trigger mode during a full arresst b/c it's going to switch for ya.

:)

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Specializes in CTICU.

The newer, fiber optic-capable consoles (either Datascope or Arrow) will automatically choose the best trigger if in the "auto/pilot" mode. If in "manual/operator" mode, you'll still have to select the AP trigger.

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thanks guys, i go to an inservice on iabp next month, i'll question them too

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Specializes in CCRN-CMC-CSC: CTICU, MICU, SICU, TRAUMA.

I did a little research on this... I think ghillbert beat me to the punch... but the pump will default to the best trigger source...

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Hi!

I JUST left an IABP class with the new company who bought datascope (can't remember their name, but they manufacture the CS100s and CS300s for example)...

The new guideleines are that you do not have to do ANYTHING when the pt codes. Let me explain...

On the old machines, you would have to switch to pressure trigger to match up the balloon inflation with compressions. Now, it does so automatically. Just start CPR.:redbeathe

However, when you defibrillate, it is important to stay away from the IABP machine.

That's the update!

:smokin:

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Specializes in CCRN-CSC.

We've been using a lot of IABPs on our post OHS patients lately and yes, they've been meeting some hard times also and have been coding: bad heart pre-op will most likely be a worse heart post-op.

Anyways, my unit CNS, manager, and IABP rep that we work with advises to place the IABP in semi-auto and on AP. From there, the IABP will go off the pressure generated from compressions and try and work that way.

But if this code is looking to be a long one, the balloon can only remain uninflated for 30 minutes. After that, it has to go... Hope this helps!

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Specializes in CCU, ED.
Hi!

I JUST left an IABP class with the new company who bought datascope (can't remember their name, but they manufacture the CS100s and CS300s for example)...

The new guideleines are that you do not have to do ANYTHING when the pt codes. Let me explain...

On the old machines, you would have to switch to pressure trigger to match up the balloon inflation with compressions. Now, it does so automatically. Just start CPR.:redbeathe

However, when you defibrillate, it is important to stay away from the IABP machine.

That's the update!

:smokin:

I believe Maquet is the company you were trying to think of.

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I can only speak for Datascope (now Maquet) as that is the one I use. If a pt codes you DON'T CHANGE ANYTHING with the machine...focus on the pt. As soon as the machine no longer senses an EGK to use as a trigger for inflation/deflation it will AUTOMATICALLY switch to pressure trigger. Once you start compressions the machine will pick up the pressure changes from the compressions and will time the IABP appropriately. Changing to pressure mode is not wrong, but there is no need as the machine already does it. Key is to focus on the pt....same if you need to defibrillate...ignore the machine.

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Specializes in Critical Care.

Definitely don't need to shut off the IABP during a code. Generally we put it in pressure mode, as others have said. The only possible rationale I can think of to leave it in EKG mode is that the newer IABP's switch between modes automatically; perhaps this is why?

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Specializes in Critical Care Nursing AKA ICU.

i was taught to put the datascope on "pressure" when coding a pt.

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Specializes in CCU, CT surgery, Case Mgmt.

Per the standards at my institution and per Datascope, we place the IABP on pressure for the pump to correlate with the compressions.

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