This 67-year-old male was admitted to the Intensive Care Unit 6 hours ago following emergency coronary artery bypass grafting. He has remained hypotensive (mean arterial pressure of 60 mmHg) and oliguric, despite adequate fluid loading to a right atrial pressure of 15 mmHg and an adrenaline infusion at 20 mg/min. A recent transoesophageal echocardiogram demonstrates global severe systolic dysfunction and no evidence of pericardial tamponade.
You have been asked to consider inserting an intra-aortic balloon pump by the attending team.
Consider your approach and preparation for this procedure.
Procedure station: Candidates were expected to provide a systematic approach to the principle of insertion, management and removal of an Intra-Aortic Balloon Pump catheter. Nineteen out of twenty-eight candidates passed this section.
Indications for IABP insertion:
No choice but pump
Probably harmless, but probably not useful
(Ideally, you'd have an IABP as a prop to hand to the candidate, so they can fiddle with it physically. The picture of my own expired IABP is included here for convenience).
This is an intra-aortic balloon pump catheter.
Its major features are:
Generally speaking, the IABPs are sized according to height.
By Seldinger technique, of course. There is a sheathed and unsheathed version of this procedure
Two main ways of checking the position:
There is early balloon inflation and early balloon deflation.
Early balloon inflation results in
Early balloon deflation results in
Two main schools of thought:
Disclaimer: the viva stem above may be an original CICM stem, acquired from their publicly available past papers. Or, perhaps it is a slightly altered version of the original CICM stem. Or, it is a completely original viva stem, concocted by the monstrously amoral author of Deranged Physiology for nothing more than his own personal amusement. In either case, because the college do not make the main viva text or marking criteria available, almost everything here has been confabulated. It might sound like a plausible viva and it could be used for the purpose of practice, but all should be aware that it does not represent the "true" canonical CICM viva station.