These issue came up in Question 13 from the first paper of 2007: "Compare and contrast the advantages and limitations of the intra-aortic balloon pump (IABP) and ventricular assist devices (VAD)."
The tabulated college answer to the question is presented below, as it represents the bare minimum expected of the CICM Fellow without any specific cardiothoracic leanings.
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, |
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.
References
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.
Mohiyaddin, Syed, et al. "PROLONGED USE OF LEVITRONIX RIGHT VENTRICULAR ASSIST DEVICE (RVAD) IN PATIENTS WITH LONG TERM LEFT VENTRICULAR ASSIST DEVICE (LVAD)." Journal of the American College of Cardiology 71.11 (2018): A811.