Sudhir Shetye

Jaslok Hospital & Research Centre

Title: A novel use of Intra-Aortic Balloon Counterpulsation (IABP) for Acute Myocardial Infarction (AMI) Complicating Cardiogenic Shock

Biography

He have been working as a senior technical executive in the cath lab at the well-known multispeciality hospital, Jaslok Hospital and Research Centre in Mumbai, India, for the last 34 years. He also the General Secretary of my organization, the Society of Paramedics Cardiovascular Technologists (SPCIT) of India, which has more than thousands of members across India.

Over the last three decades, He have been involved in scientific sessions to deliver more than 160 talks and 40 webinars across India and the globe. Recently, He gave a talk at Weber State University. During my tenure of service, He played a crucial role in training junior technologists, sharing my knowledge and technical expertise at technologists' conferences and through cardiologists' forums. He have witnessed significant advancements in medical technologies and the introduction of more sophisticated diagnostics and treatment tools.

Abstract

Introduction: Acute myocardial infarction (AMI) is a life-threatening condition that requires prompt diagnosis and treatment. IABP is often needed to increase coronary blood flow and reduce cardiac workload. However, the insertion of IABP can sometimes become challenging in the setting of cardiogenic shock. This report highlights the use of IABP for Acute Myocardial Infarction (AMI) Complicating Cardiogenic Shock and the challenges encountered in handling such cases.

Method: We report a case study of four patients, three of whom had hemodynamic collapse during angioplasty and one collapsed during transportation to the catheterisation laboratory. The blood pressure in all patients was not recordable. Managing those patients was a real challenge for interventional cardiologists. A prompt action is required to introduce intra-aortic counterpulsation therapy, for which we have to follow a specific technique given this critical scenario. An effective counterpulsation therapy requires at least 60 mm Hg of systolic pressure. All patients needed at least 2 inotropic agents.

The IABP works on electric and mechanical rhythm. The patients were in electromechanical dissociation and had a pressure drop of less than 60 mm Hg. For the adequate functioning of IABP, we kept the IABP machine on the pressure trigger source, and the IABP frequency was kept at 1:1. For adequate augmentation, chest compressions were given to generate at least a pressure of 60 mm Hg, which were synchronous with IAB counterpulsation. The chest compressions given were different from the cardio-pulmonary resuscitation such that they generated the systolic blood pressure of at least 60 mmHg. IABP was then synchronised to produce an augmented beat on the descending limb of the man made systolic blood pressure of 60 mmHg, to synchronise with inflation and deflation of the balloon. This resulted in maintaining mean arterial blood pressure to higher and better level. In one patient, the blood pressure was not even recordable. The femoral access was taken under fluoro guidance by chest compression, and a negative suction was given to the syringe at the lateral border of the femur head to get a femoral artery puncture. All patients underwent coronary revascularisation with uneventful recovery.

Conclusion: Securing access and maintaining mean arterial pressure is challenging in patients who present with cardiogenic shock. We describe a method of manual chest compression synchronous with IAB counterpulsation for proper functioning and achieving a desirable mean arterial pressure. Patience is needed, not to write off such patients, since recovery is possible.