Skip to main content
SpringerLink
Log in

Intra-Aortic Balloon Pump (IABP) in ICU: Cerebral Hemodynamics Monitoring by Transcranial Doppler (TCD/TCCS)

  • Chapter
  • First Online:
Neurosonology in Critical Care

  • 1690 Accesses

Abstract

Intra-aortic balloon pump (IABP) is an assist device commonly used in severe cardiac failure and to preoperatively support treatment of high-risk patients by improving myocardial perfusion and lowering cardiac afterload. Although its benefits for improving cardiac function have been well documented, the effects of IABP on the cerebral circulation are still not well understood. However, it has been demonstrated that the use of IABP can change the temporal pattern of cerebral blood flow waveforms during the cardiac cycle, leading to characteristic double-peaked waveforms with the occurrence of transient reversed, negative diastolic flow in some cases. Nevertheless, more information is needed about the impacts of IABP on the cerebral hemodynamic and the neurological consequences of its use. This chapter describes the use of transcranial Doppler ultrasound (TCD), a relatively inexpensive and noninvasive tool, in patients with an IABP. TCD has considerable potential for real-time bedside monitoring of these patients, allowing observation of the effects of IABP on cerebral hemodynamics and cerebral autoregulation (CA). Of considerable value is TCD/TCCS potential to detect and prevent neurological complications in this group of patients.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 139.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 179.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 249.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. White JM, Ruygrok PN. Intra-aortic balloon counterpulsation in contemporary practice where are we? Heart Lung Circ. 2015;24(4):335–41.

    Article  PubMed  Google Scholar 

  2. Morris NA, Manning N, Marshall RS, Connolly ES, Claassen J, Agarwal S, et al. Transcranial Doppler waveforms during intra-aortic balloon pump counterpulsation for vasospasm detection after subarachnoid hemorrhage. Neurosurgery. 2018;83(3):416–21.

    Article  PubMed  Google Scholar 

  3. Taccone FS, Lubicz B, Piagnerelli M, Van Nuffelen M, Vincent J-L, De Backer D. Cardiogenic shock with stunned myocardium during triple-H therapy treated with intra-aortic balloon pump counterpulsation. Neurocrit Care. 2009;10(1):76–82.

    Article  PubMed  Google Scholar 

  4. Ducruet AF, Albuquerque FC, Crowley RW, Williamson R, Forseth J, McDougall CG. Balloon-pump counterpulsation for management of severe cardiac dysfunction after aneurysmal subarachnoid hemorrhage. World Neurosurg. 2013;80(6):347.

    Article  Google Scholar 

  5. Kantrowitz A. Experimental augmentation of coronary flow by retardation of the arterial pressure pulse. Surgery. 1953;34(4):678–87.

    CAS  PubMed  Google Scholar 

  6. Vignola PA, Swaye PS, Gosselin AJ. Guidelines for effective and safe percutaneous intraaortic balloon pump insertion and removal. Am J Cardiol. 1981;48(4):660–4.

    Article  CAS  PubMed  Google Scholar 

  7. Klopman MA, Chen EP, Sniecinski RM. Positioning an intraaortic balloon pump using intraoperative transesophageal echocardiogram guidance. Anesth Analg. 2011;113(1):40–3.

    Article  PubMed  Google Scholar 

  8. Webb CAJ, Weyker PD, Flynn BC. Management of Intra-Aortic Balloon Pumps. Semin Cardiothorac Vasc Anesth. 2015;19(2):106–21.

    Article  PubMed  Google Scholar 

  9. Urschel CW, Eber L, Forrester J, Matloff J, Carpenter R, Sonnenblick E. Alteration of mechanical performance of the ventricle by intraaortic balloon counterpulsation. Am J Cardiol. 1970;25(5):546–51.

    Article  CAS  PubMed  Google Scholar 

  10. Williams DO, Korr KS, Gewirtz H, Most AS. The effect of intraaortic balloon counterpulsation on regional myocardial blood flow and oxygen consumption in the presence of coronary artery stenosis in patients with unstable angina. Circulation. 1982;66(3):593–7.

    Article  CAS  PubMed  Google Scholar 

  11. Kern MJ, Aguirre F, Bach R, Donohue T, Siegel R, Segal J. Augmentation of coronary blood flow by intra-aortic balloon pumping in patients after coronary angioplasty. Circulation. 1993;87(2):500–11.

    Article  CAS  PubMed  Google Scholar 

  12. Patel JJ, Kopisyansky C, Boston B, Kuretu ML, McBride R, Cohen M. Prospective evaluation of complications associated with percutaneous intraaortic balloon counterpulsation. Am J Cardiol. 1995;76(16):1205–7.

    Article  CAS  PubMed  Google Scholar 

  13. Beholz S, Braun J, Ansorge K, Wollert HG, Eckel L. Paraplegia caused by aortic dissection after intraaortic balloon pump assist. Ann Thorac Surg. 1998;65(2):603–4.

    CAS  PubMed  Google Scholar 

  14. Cruz-Flores S, Diamond AL, Leira EC. Cerebral air embolism secondary to intra-aortic balloon pump rupture. Neurocrit Care. 2005;2(1):49–50.

    Article  PubMed  Google Scholar 

  15. Honet JC, Wajszczuk WJ, Rubenfire M, Kantrowitz A, Raikes JA. Neurological abnormalities in the leg(s) after use of intraaortic balloon pump: report of six cases. Arch Phys Med Rehabil. 1975;56(8):346–52.

    CAS  PubMed  Google Scholar 

  16. Al-Mufti F, Morris N, Lahiri S, Roth W, Witsch J, Machado I, et al. Use of intra-aortic- balloon pump counterpulsation in patients with symptomatic vasospasm following subarachnoid Hemorrhage and neurogenic stress cardiomyopathy. J Vasc Interv Neurol. 2016;9(1):28–34.

    PubMed  PubMed Central  Google Scholar 

  17. Kerro A, Woods T, Chang JJ. Neurogenic stunned myocardium in subarachnoid hemorrhage. J Crit Care. 2017;38:27–34.

    Article  PubMed  Google Scholar 

  18. Lazaridis C, Pradilla G, Nyquist PA, Tamargo RJ. Intra-aortic balloon pump counterpulsation in the setting of subarachnoid hemorrhage, cerebral vasospasm, and neurogenic stress cardiomyopathy. Case report and review of the literature. Neurocrit Care. 2010;13(1):101–8.

    Article  PubMed  Google Scholar 

  19. Milinis K, Thapar A, O’Neill K, Davies AH. History of aneurysmal spontaneous subarachnoid hemorrhage. Stroke. 2017;48(10):e280–3.

    Article  PubMed  Google Scholar 

  20. Dumont AS, Dumont RJ, Chow MM, Lin C-L, Calisaneller T, Ley KF, et al. Cerebral vasospasm after subarachnoid hemorrhage: putative role of inflammation. Neurosurgery. 2003;53(1):123–33; discussion 133–135.

    Article  PubMed  Google Scholar 

  21. Cheung AT, Levy WJ, Weiss SJ, Barclay DK, Stecker MM. Relationships between cerebral blood flow velocities and arterial pressures during intra-aortic counterpulsation. J Cardiothorac Vasc Anesth. 1998;12(1):51–7.

    Article  CAS  PubMed  Google Scholar 

  22. Schachtrupp A, Wrigge H, Busch T, Buhre W, Weyland A. Influence of intra-aortic balloon pumping on cerebral blood flow pattern in patients after cardiac surgery. Eur J Anaesthesiol. 2005;22(3):165–70.

    Article  CAS  PubMed  Google Scholar 

  23. Pfluecke C, Christoph M, Kolschmann S, Tarnowski D, Forkmann M, Jellinghaus S, et al. Intra-aortic balloon pump (IABP) counterpulsation improves cerebral perfusion in patients with decreased left ventricular function. Perfusion. 2014;29(6):511–6.

    Article  CAS  PubMed  Google Scholar 

  24. Brass LM. Reversed intracranial blood flow in patients with an intra-aortic balloon pump. Stroke. 1990;21(3):484–7.

    Article  CAS  PubMed  Google Scholar 

  25. van der Naalt J, Baker AJ. Influence of the intra-aortic balloon pump on the transcranial Doppler flow pattern in a brain-dead patient. Stroke. 1996;27(1):140–2.

    Article  PubMed  Google Scholar 

  26. Caldas JR, Panerai RB, Passos R, et al. Is there still a place for transcranial Doppler in patients with IABP? Crit Care. 2020;24:625.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Gao Y-Z, Zhang M. Effect of intra-aortic balloon pump on reversal of diastolic cerebral flow: deflated too early? Neurocrit Care. 2018;29:313–4.

    Article  PubMed  Google Scholar 

  28. Schutt RC, Bhimiraj A, Estep JD, Guha A, Trachtenberg BH, Garami Z. Deflation timing influences intra-aortic balloon pump-mediated carotid blood flow reversal: a case report. Circ Heart Fail. 2016;9(9):e003474.

    Google Scholar 

  29. Paulson OB, Strandgaard S, Edvinsson L. Cerebral autoregulation. Cerebrovasc Brain Metab Rev. 1990;2(2):161–92.

    CAS  PubMed  Google Scholar 

  30. Aaslid R, Lindegaard KF, Sorteberg W, Nornes H. Cerebral autoregulation dynamics in humans. Stroke. 1989;20(1):45–52.

    Article  CAS  PubMed  Google Scholar 

  31. Tiecks FP, Lam AM, Aaslid R, Newell DW. Comparison of static and dynamic cerebral autoregulation measurements. Stroke. 1995;26(6):1014–9.

    Article  CAS  PubMed  Google Scholar 

  32. Panerai RB. Transcranial Doppler for evaluation of cerebral autoregulation. Clin Auton Res. 2009;19(4):197–211.

    Article  PubMed  Google Scholar 

  33. Tzeng YC, Ainslie PN, Cooke WH, Peebles KC, Willie CK, MacRae BA, et al. Assessment of cerebral autoregulation: the quandary of quantification. Am J Physiol Circ Physiol. 2012;303(6):658.

    Article  Google Scholar 

  34. Scolletta S, Taccone FS, Donadello K. Brain injury after cardiac surgery. Minerva Anestesiol. 2015;81(6):662–77.

    CAS  PubMed  Google Scholar 

  35. Brown CH 4th, Faigle R, Klinker L, Bahouth M, Max L, LaFlam A, et al. The association of brain MRI characteristics and postoperative delirium in cardiac surgery patients. Clin Ther. 2015;37(12):2699.e9.

    Google Scholar 

  36. Koster S, Hensens AG, Schuurmans MJ, van der Palen J. Risk factors of delirium after cardiac surgery: a systematic review. Eur J Cardiovasc Nurs. 2011;10(4):197–204.

    Article  PubMed  Google Scholar 

  37. Caldas JR, Panerai RB, Bor-Seng-Shu E, Almeida JP, Ferreira GSR, Camara L, et al. Cerebral hemodynamics with intra-aortic balloon pump: business as usual? Physiol Meas. 2017;38(7):1349–61.

    Article  CAS  PubMed  Google Scholar 

  38. Bellapart J, Geng S, Dunster K, Timms D, Barnett AG, Boots R, et al. Intraaortic balloon pump counterpulsation and cerebral autoregulation: an observational study. BMC Anesthesiol. 2010;10:3.

    Google Scholar 

  39. Schramm P, Klein KU, Falkenberg L, Berres M, Closhen D, Werhahn KJ, et al. Impaired cerebrovascular autoregulation in patients with severe sepsis and sepsis-associated delirium. Crit Care. 2012;16(5):181.

    Article  Google Scholar 

  40. Salinet AS, Panerai RB, Robinson TG. The longitudinal evolution of cerebral blood flow regulation after acute ischaemic stroke. Cerebrovasc Dis Extra. 2014;4(2):186–97.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Ma H, Guo ZN, Liu J, Xing Y, Zhao R, Yang Y. Temporal course of dynamic cerebral autoregulation in patients with intracerebral hemorrhage. Stroke. 2016;47(3):674–81.

    Article  CAS  PubMed  Google Scholar 

  42. Caldas JR, Panerai RB, Haunton VJ, Almeida JP, Ferreira GSR, Camara L, et al. Cerebral blood flow autoregulation in ischemic heart failure. Am J Physiol Regul Integr Comp Physiol. 2016;312:108–13.

    Article  Google Scholar 

  43. Budohoski KP, Czosnyka M, Kirkpatrick PJ, Reinhard M, Varsos GV, Kasprowicz M, et al. Bilateral failure of cerebral autoregulation is related to unfavorable outcome after subarachnoid hemorrhage. Neurocrit Care. 2015;22(1):65–73.

    Article  PubMed  Google Scholar 

  44. Caldas JR, Haunton VJ, Panerai RB, Hajjar LA, Robinson TG. Cerebral autoregulation in cardiopulmonary bypass surgery: a systematic review. Interact Cardiovasc Thorac Surg. 2017;6

    Google Scholar 

  45. Kunt A, Atbas C, Hidiroglu M, Cetin L, Erdogan KE, Kucuker A, et al. Predictors and outcomes of minor cerebrovascular events after cardiac surgery: a multivariable analysis of 1346 patients. J Cardiovasc Surg. 2013;54(4):537–43.

    CAS  Google Scholar 

  46. Al-Atassi T, Lam K, Forgie M, Boodhwani M, Rubens F, Hendry P, et al. Cerebral microembolization after bioprosthetic aortic valve replacement comparison of warfarin plus aspirin versus aspirin only. Circulation. 2012;126(11):S239–44.

    Google Scholar 

  47. Barbut D, Yao FSF, Lo YW, Silverman R, Hager DN, Trifiletti RR, et al. Determination of size of aortic emboli and embolic load during coronary artery bypass grafting. Ann Thorac Surg. 1997;63(5):1262–7.

    Article  CAS  PubMed  Google Scholar 

  48. Furman S, Vijaynagar R, Rosenbaum R, McMullen M, Escher DJ. Lethal sequelae of intra-aortic balloon rupture. Surgery. 1971;69(1):121–9.

    CAS  PubMed  Google Scholar 

  49. Ropper AH, Kehne SM, Wechsler L. Transcranial Doppler in brain death. Neurology. 1987;37(11):1733–5.

    Article  CAS  PubMed  Google Scholar 

  50. Caldas JR, Panerai RB, Bor-Seng-Shu E, et al. Intra-aortic balloon pump does not influence cerebral hemodynamics and neurological outcomes in high-risk cardiac patients undergoing cardiac surgery: an analysis of the IABCS trial. Ann Intensive Care. 2019;9(1):130.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Murli K, Zacharowski K. Principles of intra-aortic balloon pump counterpulsation. Contin Educ Anaesth Crit Care Pain. ScienceDirect. 2009;9(1):24–8.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Anesthesia, University of Sao Paulo, Butanta, Sao Paulo, Brazil

    Juliana Caldas

  2. Critical Care Unit Hospital São Rafael Salvador, Salvador, Brazil

    Juliana Caldas

  3. Department of Cardiovascular Sciences, University of Leicester, Leicester, UK

    Ronney B. Panerai

Authors
  1. Juliana Caldas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ronney B. Panerai
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Juliana Caldas .

Editor information

Editors and Affiliations

  1. Department of Critical Care, University of Buenos Aires, Buenos Aires, Argentina

    Camilo N. Rodríguez

  2. Stroke Unit & Neurosonology Lab, University of Padua School of Medicine, Padova, Italy

    Claudio Baracchini

  3. Department of Critical Care and Anesthesiology, Fundación Valle del Lili, Cali, Colombia

    Jorge H. Mejia-Mantilla

  4. Department of Clinical Neurosciences Cambridge Biomedical Campus, University of Cambridge, Cambridge, UK

    Marek Czosnyka

  5. Departments of Anesthesiology and Critical Care Medicine, Neurology, and Neurosurgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Jose I Suarez

  6. President of Hungarian Neurological Society, Department of Neurology, Clinical Center Debrecen University, Debrecen, Hungary

    László Csiba

  7. Intensive Care Unit, Clinics Hospital, Universidad de la Republica School of Medicine, Montevideo, Uruguay

    Corina Puppo

  8. Center for Neurological Vascular Diagnostics, Munich, Germany

    Eva Bartels

Algorithm

Algorithm

figure a

ABCD Airway-breathing-circulation-disability, IABP Intra-aortic balloon pump, CA Cerebral autoregulation, ABP Arterial blood pressure, MCA Middle cerebral artery, CBFV Cerebral blood flow velocity, PSV Peak systolic velocity, MFV Mean flow velocity, EDV End-diastolic velocity, SAH Subarachnoid hemorrhage; ** If the complementary exam is needed

Rights and permissions

Reprints and permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Caldas, J., Panerai, R.B. (2022). Intra-Aortic Balloon Pump (IABP) in ICU: Cerebral Hemodynamics Monitoring by Transcranial Doppler (TCD/TCCS). In: Rodríguez, C.N., et al. Neurosonology in Critical Care . Springer, Cham. https://doi.org/10.1007/978-3-030-81419-9_61

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-81419-9_61

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-81418-2

  • Online ISBN: 978-3-030-81419-9

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation