Guidelines for effective and safe percutaneous intraaortic balloon pump insertion and removal

During the 12 month period beginning February 1980, a total of 54 consecutive patients had 60 attempts at percutaneous insertion of an intraaortic balloon because of medically uncontrollable angina, cardiogenic shock either in the setting of an acute myocardial infarction or within hours of cardiac surgery and as a prophylactic measure in high risk patients before cardiac surgery. The balloon was successfully inserted in 49 patients (91 percent). In five patients the balloon could not be inserted in spite of eight attempts because of tortuosity of the iliac artery. All nine patients in whom balloon insertion was attempted without fluoroscopy had the device inserted successfully. The four insertion attempts during cardiac massage were all successful. Experience with use of the new longer introducer sheath is described. Since its acquisition there has not been a single balloon pump insertion failure in 20 consecutive patients including 6 patients in whom initial attempts through the conventional short sheath were unsuccessful because of iliac tortuosity. The major complications encountered in the present series were thromboembolic: femoral arterial thrombosis developed in five patients (10.2 percent) and an asymptomatic pulse loss in the contralateral foot developed in another. There were no cases of pseudoaneurysm, groin hematoma, aortic dissection or infection related to the percutaneous balloon. On the basis of this experience, several guidelines are suggested for safe and effective percutaneous insertions and removal of the intraaortic balloon pump.