IABP Alternative

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What medications could be used to reduce the afterload for the left ventricle without compromising coronary perfusion, essentially a IABP alternative?

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When you need an IABP, there is no alternative.

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Let's say... it's the zombie apocalypse. No access to IABP. Your patient has extremely low EF and you need to increase cardiac output NOW. What do you give?

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Trick question? Epi.

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Specializes in OR, Nursing Professional Development.

An Impella? Stat consult to the cardiac surgeon for a CABG/VAD/whatever the appropriate surgery is? If someone is at the point of needing an IABP, medications aren't doing enough.

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Specializes in Critical care.

Is this homework?

Generally, iabp, impella etc are an escalation when medication alone is not working.

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I laughed! No not homework but I'm anticipating this being an interview question. I was hoping to improve my anticipated response.

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Specializes in Critical Care Nursing.

If you are just looking to buy the patient some time until you can get an IABP, an inodilator like dobutamine might help. The thing is to figure out what is going to be done longterm, like is the patient getting valve surgery or a LVAD.

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I laughed! No not homework but I'm anticipating this being an interview question. I was hoping to improve my anticipated response.

Well, if you do get asked the question, keep it simple. Wandering out into the tall weeds will just get you naming every drip in the book and making it look like you're grasping at straws.

I stand by my answer. You got a guy dying from LV failure? The answer is an epi drip. And he still might die.

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Bi V pacing can help increase EF but not always instantly. The IABP is a great tool. Not all hospitals have the Impella . I agree with Dobutrex for it's inotropic properties. Epi will vaso constrict increasing after load. Primacor Ntg and Nipride can vasodilate.

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Start some dobutamine then some vasopressin to counteract the drop in SVR then NE to add some inotrope in the presence of the rise in afterload then add some epi because the CO will probably fall from the vaso and NE then some milrinone to improve return to the left heart then turn up the vaso and NE because the milrinone will drop the afterload and then.....put in an IABP.

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I literally laughed out loud! I'll try to stay out of the weeds. Thank you for your responses. Helpful and entertaining :)

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