No, they don™t. While it is true that these patients tend to be more sick, balloon pumps can also be used as an adjunct to high-risk interventional procedures. Most of the time, however, in my experience, these people have had damage to their hearts and their hearts don™t pump well. Or they have chest pain that won™t go away. Balloon pumps reduce the heart™s workload. The balloon pump™s inflation sends more blood and oxygen to the coronary beds and feeds the myocardium. In addition to feeding the heart muscle, it also reduces afterload (the resistance to ejection). The heart in turn does not have to pump as hard to get the job done.

You may also notice, if the patient is hypotensive or in cardiogenic shock, that their fingers, toes and maybe even their lips, are blue. The vessels are constricting to push blood to the core of the body where it is needed most. When a balloon pump is in place and working properly, you will hopefully notice the blood pressure coming up because of the pump (augmentation), and the peripheral limbs regaining their color.

Proper placement of the balloon pump can only be confirmed by an A.P. chest x-ray. The tip of the balloon should be in the second and third intercostal space. You should check the radial pulse on the left side regularly. If there is no radial pulse, the balloon is too high. Urine output should be measured. If there is little to none in a patient who produced urine before, the balloon is probably too low. In both of these cases, the physician should be contacted immediately and the balloon repositioned. The organs (kidneys, brain, etc.) can only tolerate intermittent ischemia for about an hour before you have damage. Also, be sure to watch for neurological signs that the patient may be suffering from a stroke. Facial droop, slurred speech, and/or innapropriate speech (inappropriate responses to common questions, i.e., if you ask, What day is today?" and the patient™s answer is Sally.)

Balloon pumps are wonderful pieces of equipment and have saved and improved many people™s lives, but just like most of what we use in the cath lab, it has to be used properly or the results can be very damaging.

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Jason Wilson, RCIS
Ellis Hospital Clinical Instructor
Schenectady, New York
hrtfixr7@yahoo.com