IABP: Why is augmentation better in 1:2?

[nightshift82]

I work at a small community hospital which used the Arrow/Teleflex IABP for years and we have recently switched from Arrow AutoCAT II to Datascope Cardiosave Hybrid. There was very little support from the company compared to Arrow which is very frustrating. I have read the manual over 200 pages. I was told that these two consoles use very different technologies and that there is not a bellows system with Datascope/Maquet? Does anyone use this console and my second question is that we have had the interventionist order 1:2 instead of 1:1 for the frequency in two of the most recent post-PCI patients with DHF/cardiogenic shock on levophed which makes no sense to me and he could not explain the rational. Timing was good with regards to inflation and deflation points with augmentation 80 and MAP 60. These patients did not get worse but they did not get any better and both were flown out. Both were on intubated and HR were between 90-120. I was not sure if the reason was because of the HR but I thought that 1:2 was for HR >150?

[nightshift82]

Sorry I forgot to add that I do not know the LVEDP and both were SR-ST not AF and were large AWMI. I did not take care of them but was posed the question. Also with this same console I did care for a patient who had a great ECG and R wave...no arrhythmias and the new Cardiosave Hybrid would stop pumping and alarm trigger loss and go to pressure mode. I would have to force it back to ECG trigger by pulling the pressure cable...augmentation was better in ECG trigger. I had already changed all te electrodes before I resorted to pulling the pressure cable in and out. I was close to replacing the ECG cable from our other IABP and calling the hotline when it finally stopped?? I was told this happened again with our last patient. Anyone having this issue?

[Nursingbride12]

While I am not sure of the different models, I have worked with IABP for years and have discovered that they are absolutely fascinating machines. The biggest thing with them is PERFUSION. PERFUSION PERFUSION PERFUSION. The thing with balloon pumps is they are temporary. They are a temporary fix to a heart that is not being perfused. If the interventionist switched the patient to a 1:2 it is a move in a positive direction. Sounds like your patient needs a more permanent VAD considering the pressers the patient is on.

[nightshift82]

Thanks for your response...I thought I was crazy. One of the patients died and the other for possible LVAD at the transfer hospital. I did speak with the Datascope RN for our region and confirmed the same 1:1 for frequency. I have not been able to catch up with the interventionist. As for some of the strange issues with the pump console I was told to video it and send the clip to the hotline.... had not thought of that b/c with the other console your would it up with the phone cable to the hotline.

[MunoRN, RN]

We use the Datascope and I've never heard that 1:2 would provide better support than 1:1 (with a manageable heart rate). Our docs always prefer 1:2 if we can get by with 1:2, less support is always better if the patient can tolerate less support.