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NURS 287 (31)


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NURS 287
Rick Nilson

CIRCULATORY ASSIST DEVICES  Circulatory assist devices (CADs) decrease cardiac work and improve organ perfusion when conventional drug therapy is no longer adequate.  CADs provide interim support in three types of situations: (1) the left, right, or both ventricles require support while recovering from acute injury; (2) the heart requires surgical repair (e.g., a ruptured septum), but the patient must be stabilized; and (3) the heart has failed, and the patient is awaiting cardiac transplantation. Intraaortic Balloon Pump  The intraaortic balloon pump (IABP) provides temporary circulatory assistance to the compromised heart by reducing afterload (via reduction in systolic pressure) and augmenting the aortic diastolic pressure resulting in improved coronary blood flow and perfusion of vital organs.  The IABP consists of a sausage-shaped balloon, a pump that inflates and deflates the balloon, control panel for synchronizing the balloon inflation to the cardiac cycle, and fail-safe features.  IABP therapy is referred to as counterpulsation because the timing of balloon inflation is opposite to ventricular contraction.  The IAPB assist ratio is 1:1 in the acute phase of treatment, that is, one IABP cycle of inflation and deflation for every heartbeat.  Complications of IABP therapy may include vascular injuries such as dislodging of plaque, aortic dissection, and compromised distal circulation. o Thrombus and embolus formation add to the risk of circulatory compromise to the extremity. o Mechanical complications are rare and include improper timing of balloon inflation causing increased afterload, decreased CO, myocardial ischemia, and increased myocardial oxygen demand.
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