IABP and CPR

joeyzstj, LPN · Aug 22, 2008

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.

You can do a few things. You can put it into semi-auto mode and change to arterial pressure trigger or ECG mode (according to DataScope) if you werent already in that, so that it will inflate and deflate according to compressions. Datascope doesnt list it in the manual I have, however You can also turn it off and Hook a 60cc syringe to the balloon port and inflate and deflate it every so often manually. I cant remember what exactly they recommend. I would have someone doing it at least a few times in a five minute period. Datascope.com has a good section on thier site under the education section.

seanpdent, ADN, BSN, MSN, APRN, NP · Aug 22, 2008

I don't know about you.. but 'syncing' compressions in a 'code' situation.. may be a tad difficult.

Thanks for the great info though!

allnurses Guide · Aug 22, 2008

You do not turn the IABP off or manually inflate the balloon in 99.99% of cases.

Used to be, you used the "internal mode" which ran at a fixed rate of 40 bpm, however this can lead to asynchony between compressions and balloon inflation == bad.

Now, the recommendation is to switch to arterial pressure (AP) trigger (if you're in ECG or pacer trigger) and do compressions as usual. As long as you create adequate pressure with your compression (differs - 60mmHg with Datascope, only 12mmHg with the Arrow), the balloon will inflate to the change in arterial pressure and in theory at least, can augment your compressions by inflating and increasing peak diastolic pressure.

So basically - leave on, press "AP" trigger.

NoviceToExpert · Sep 7, 2008

The rationale for inflating it isn't to synchronize with compressions... but if the pt makes it through the code they are definitely going to need the IABP support... if the balloon stays down for 20 minutes (I think it's 20 minutes) or more it needs to come out because of risk of complications from the balloon being down... so you need to keep it going periodically... If you have it off for a 40 minute code... you lose the IABP option....

joeyzstj, LPN · Sep 7, 2008

The formation of clots on the balloon after being down so long are the main reason to keep it inflated perioidically.

allnurses Guide · Sep 7, 2008

The rationale for inflating it isn't to synchronize with compressions... but if the pt makes it through the code they are definitely going to need the IABP support...

The rationale for using AP trigger IS to sync with compressions as well as to avoid NOT syncing with compressions and causing obstructions to LV outflow.

If it was just prevention of balloon thrombi, you would leave in internal trigger, which is not recommended due to the risk of the balloon inflating during LV ejection.

OptimusPrime · Sep 7, 2008

Talked to a Datascope rep and another one of our more experineced ICU RN's the other day and they both said that during CPR, leave the IABP on EKG trigger.

I questioned them, just to make sure, and they both said that switching to AP during CPR is old, leave it on EKG trigger.

Thoughts?

NoviceToExpert · Sep 7, 2008

The rationale for using AP trigger IS to sync with compressions as well as to avoid NOT syncing with compressions and causing obstructions to LV outflow.
If it was just prevention of balloon thrombi, you would leave in internal trigger, which is not recommended due to the risk of the balloon inflating during LV ejection.

Thanks for the comment... my original response was addressing the comment just prior to mine where the poster said sync-ing with compressions would be just a tad difficult in response to another comment speaking of manual inflation which I don't think was the intended suggestion of the nurse who spoke of manual inflation to begin with)... which is rare to do... as someone else pointed out... not as a suggestion of mode for a code...but to point out that if the IABP is turned off or to standby that it is important to periodically get that balloon up before it's too late...

I had heard that AP triggering is appropriate in such a situation... but now I am curious as to the last comment put up referencing seemingly new recommendations by Datascope... I know a Datascope rep and maybe I'll put in a call to her and ask what they are currently recommending...

Hmmmm.... I've only had one code with an IABP in place myself... so it hasn't been frequent by any means... but I'd sure like to know if it comes up again...

Thanks again...

allnurses Guide · Sep 7, 2008

Talked to a Datascope rep and another one of our more experineced ICU RN's the other day and they both said that during CPR, leave the IABP on EKG trigger.
I questioned them, just to make sure, and they both said that switching to AP during CPR is old, leave it on EKG trigger.
Thoughts?

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.

NoviceToExpert · Sep 7, 2008

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 also agree... why would you use EKG trigger in a code? Isn't it then also possible that the balloon is going to remain deflated and clot up if you don't get any electrical potential to trigger the pump until you have a rhythm back? Makes sense to me to stay with AP.

OptimusPrime · Sep 8, 2008

I'm not exactly sure what their rational for this is... I work again Tues. so I'll find out exactly what our policy is and exactly what datascope recommends, and if it is EKG triggering, I'll find out why...

Thanks for the replies so far...