RCIS Intra-Aortic Balloon Pump and Mechanical Circulatory Support 2 — Questions and Answers
Question 1: Early IABP inflation (before the dicrotic notch) results in:
- Improved diastolic augmentation
- Increased afterload and aortic valve obstruction (Correct answer)
- Decreased heart rate
- Improved coronary perfusion
Correct answer: Increased afterload and aortic valve obstruction
Early inflation before aortic valve closure obstructs ventricular ejection, increasing afterload and potentially causing aortic valve damage.
Question 2: The Impella device provides hemodynamic support by:
- Augmenting diastolic aortic pressure
- Actively pumping blood from the left ventricle into the aorta (Correct answer)
- Oxygenating blood through a membrane
- Reducing heart rate to decrease oxygen demand
Correct answer: Actively pumping blood from the left ventricle into the aorta
The Impella is an axial flow pump that aspirates blood from the left ventricle and ejects it into the ascending aorta, directly unloading the LV.
Question 3: For correct Impella CP positioning, the inlet area of the device should be located:
- In the left atrium
- 3.5 cm below the aortic valve in the left ventricle (Correct answer)
- At the mitral valve
- In the left ventricular apex
Correct answer: 3.5 cm below the aortic valve in the left ventricle
The inlet should be approximately 3.5 cm below the aortic valve in the LV to prevent suction events and ensure adequate support.
Question 4: A common complication of IABP use is:
- Pulmonary embolism
- Limb ischemia at the insertion site (Correct answer)
- Hyperkalemia
- Aortic stenosis
Correct answer: Limb ischemia at the insertion site
Limb ischemia distal to the insertion site is a common vascular complication due to occlusion of the femoral artery by the IABP catheter.
Question 5: Which condition is a contraindication to Impella device use?
- Cardiogenic shock
- Severe aortic stenosis
- Mechanical aortic valve (Correct answer)
- Low cardiac output state
Correct answer: Mechanical aortic valve
A mechanical aortic valve is a contraindication because the Impella must cross the aortic valve, which would damage both the device and the prosthetic valve.
Question 6: Late IABP deflation (deflation during systole) causes:
- Improved ventricular unloading
- Increased afterload (Correct answer)
- Decreased diastolic augmentation
- Improved stroke volume
Correct answer: Increased afterload
Late deflation means the balloon is still partially inflated as systole begins, increasing resistance against which the ventricle must eject, thereby increasing afterload.
Question 7: The TandemHeart device provides left heart support by:
- Withdrawing blood from the left ventricle and returning it to the aorta
- Withdrawing oxygenated blood from the left atrium via a transseptal catheter and pumping it to the femoral artery (Correct answer)
- Inflating during diastole to augment coronary perfusion
- Providing extracorporeal oxygenation
Correct answer: Withdrawing oxygenated blood from the left atrium via a transseptal catheter and pumping it to the femoral artery
TandemHeart withdraws oxygenated blood from the left atrium via a transseptal catheter and pumps it to the femoral artery, bypassing the left ventricle.
RCIS Intra-Aortic Balloon Pump and Mechanical Circulatory Support 2
Early IABP inflation (before the dicrotic notch) results in: