Case Study | July 15, 2007

Overcoming Electrosurgical Interference in IABP Therapy

Combined use of AutoPilot and FiberOptix IAB Sensor Signal contribute to consistent therapy delivery.

Top panel: ECG (green) Middle panel: FiberOptix Sensor arterial pressure (blue) fluid-filled arterial pressure (red) Bottom panel: balloon pressure waveform (blue)

Top panel: ECG (green) Middle panel: FiberOptix Sensor arterial pressure (blue) fluid-filled arterial pressure (red) Bottom panel: balloon pressure waveform (blue)

Maintaining a continuous, accurate arterial pressure (AP) signal in the presence of electrosurgical interference is paramount to ensuring precise triggering and timing parameters. It has been demonstrated that heart failure patients on IABP therapy can experience timing errors during arrhythmias that can adversely affect left ventricular (LV) performance. Also, the delays and distortions of traditional fluid-filled transducer systems have been shown to interfere with timing, contributing to a misrepresentation of hemodynamics. Therefore, continued triggering of the pump and precise timing of balloon inflation in spite of irregular heartbeats are critical to effective IABP therapy in the OR environment.
A 57-year-old patient presented with severe functional mitral regurgitation and advanced LV dysfunction (ejection fraction = 25 percent). The patient’s EuroSCORE was 7 and predicted mortality was eight percent. The patient underwent a mitral valve repair and was supported with intra-aortic balloon pump (IABP) therapy — using the AutoCAT 2 WAVE — during the procedure due to anticipated problems of arrhythmias and low cardiac output. Potential interference of adequate IABP function from other electrical devices used in patient care, such as pacer and cautery, were anticipated. The combined use of Arrow International’s FiberOptix Sensor Signal and AutoPilot mode of operation was able to overcome repeated electrical interference to delivery, providing timely and consistent IABP support, even during arrhythmic episodes.
IABP Response
During the procedure, the use of cautery caused interference with the ECG signal as a trigger source and the fluid-filled AP waveform continually dampened. The AutoPilot operational mode combined with the clear, precise AP signal from the FiberOptix IAB allowed consistent IABP operation to continue, and after the patient’s ECG was stabilized, AutoPilot returned to ECG triggering.
When cautery was used again later in the procedure, AutoPilot automatically switched back to AP trigger using the unaffected fiber optic AP signal. After bypass, high pacer output interfered with appropriate ECG signal recognition; adjustments to the pacer output and ECG gain allowed for consistent IABP support in the immediate postoperative period. The postoperative course continued to be uneventful and well supported until completion of IABP therapy. The patient was removed from IABP support after 48 hours, extubated and discharged from the ICU.
Successful Outcome
The combined use of AutoPilot mode of operation and FiberOptix IAB Sensor Signal was able to successfully overcome electrosurgical interference. The stability of the IABP support was maintained during the time of treatment, allowing a smooth postoperative course for the very high-risk patient.
The clinical benefits of improved timing and triggering accuracy for optimized IABP management are direct results of the fiber optic system’s ability to overcome interference associated with traditional fluid-filled AP signal acquisitions.
1. Schreuder JJ, Maisano F, Donelli A, et al. Beat-to-beat effects of intraaortic balloon pump timing on left ventricular performance in patients with low ejection fraction. Ann Thorac Surg. 2005; 79:872-880.
2. Pantalos GM, Gillars KJ, Dowling RD, et al. Intraaortic balloon pump (IABP) timing errors in adult patients. ASAIO J. 2003; 49:155.
3. Nashef SA, Roques F, Michel P, et al. European system for cardiac operative risk evaluation (EuroSCORE). Eur J Cardiothorac Surg. 1999; 16:9-13.

Related Content

Getinge Issues Worldwide Voluntary Correction of Maquet/Getinge Cardiosave Intra-Aortic Balloon Pump
News | Intra-Aortic Balloon Pumps (IABP) | September 24, 2018
September 24, 2018 — Getinge is voluntarily initiating a worldwide recall involving a field correction of approximate
Maquet Datascope Corp. is recalling the CardioSave Hybrid Intra-aortic Balloon Pump (IABP).

The touchscreen Maquet Datascope CardioSave Hybrid Intra-aortic Balloon Pump (IABP) system console.

News | Intra-Aortic Balloon Pumps (IABP) | June 06, 2018
June 6, 2018 — Maquet Datascope Corp.
An example of an intra-aortic balloon pump (IABP) from Maquet. The results of the SEMPER FI trial. #europcr2018 #Europcr

An example of an intra-aortic balloon pump (IABP) from Maquet. 

Feature | Intra-Aortic Balloon Pumps (IABP) | May 31, 2018
May 31, 2018 — The results from the Survival Improvement in Extensive Myocardial Infarction with PERsistent Ischemia
FDA Clears Teleflex Arrow AC3 Optimus Intra-Aortic Balloon Pump (IABP)
Technology | Intra-Aortic Balloon Pumps (IABP) | May 02, 2017
May 2, 2017 — The U.S. Food and Drug Administration (FDA) granted 510(k) clearance for the Teleflex Inc.
Impella CP heart pump, TCT 2016, intra-aortic balloon counterpulsation, IABP, clinical study
News | Intra-Aortic Balloon Pumps (IABP) | January 03, 2017 | Dave Fornell
The Impella CP heart pump (Abiomed) demonstrated no improvement in mortality for patients with myocardial infarction...
Teleflex, Arrow IAB catheter, intra-aortic balloon pump, worldwide recall
News | Intra-Aortic Balloon Pumps (IABP) | March 11, 2016
Teleflex Inc. announced the worldwide recall of Arrow International intra-aortic balloon catheter kits and percutaneous...