Compare and contrast the advantages and limitations of the intra-aortic balloon pump (IABP) and ventricular assist devices (VAD). (You may tabulate your answer).
IABP |
VAD |
|
Can be inserted percutaneously in ICU or CCU |
While percutaneous insertion is possible, frequently require |
|
Indications |
Used post cardiac surgery / |
Frequently used in post |
Logistics |
Intensivists more familiar Can be used during transport |
Less familiar with VAD, |
Anticoagulation |
Usually no need for anticoagulation |
Need for anticoagulation |
Not effective in the setting of CI < 1.2 and |
Greater control on overall |
|
Complications |
Lower limb ischemia, |
Bleeding, infection, |
I love it when they invite you to tabulate your answer.
Among the things worth mentioning is the horrific rate of infectious complications with the VAD (up to 50% of patients have an LVAD-associated infection) and the fact that its not merely anticoagulation, but insane anticoagulation that is required (APTT target is 150-200).
It is difficult to compare the two therapies, of course. An IABP is a supportive treatment to assist the recovering cardiac patient. The VAD is essentially a mechanical heart. There are reports of people who were awake, and asystolic, with a VAD in situ.
Beyond the tabulated answer offered here, the following chapters may be meaningful:
A slightly expanded answer, with more detail, is also offered:
IABP |
VAD |
|
Indications |
No choice but pump
Probably harmless, but probably not useful
Totally experimental
Known to be pointl |
Firm indications:
Potential indications:
|
Contraindications |
Absolute contraindications
Relative contraindications
|
|
Advantages |
|
|
Disadvantages |
|
|
Anticoagulation |
May not require anticoagulation |
Requires mandatory anticoagulation |
Complications |
|
|
Even more broadly, the chapter on mechanical haemodynamic support strategies contains a comparison of several other mechanical methods of increasing cardiac output.
To the tabulated answer presented here, I would add a reference or two to aid those (like me) who have never even seen a VAD.
UpToDate has a nice chapter on VADs.
My own barebones summary of the VAD is available here. IABP receives a slightly more elaborate treatment here.
EMCrit brandishes the expertise of somebody who works with these things, and I take that seriously.
Additionally, there is an insanely colourful brochure which has device-specific recommendations.