Evaluating the efficacy of intra-aortic balloon pump timing using the auto-timing mode of operation with the Datascope CS100.
The intra-aortic balloon pump (IABP) was first introduced by Moulopoulos et al. in 1962 and was described clinically by Kantrowitz et al. in 1968. The subsequent development of the IABP has resulted in its widespread application, resulting in >70,000 applications per year, making it the most common cardiac assist device after pharmacologic intervention. The correct timing of the inflation and deflation of this device is critical to it being clinically advantageous to the patient. The purpose of this study was primarily to examine the Datascope CS100 automated timing of inflation and deflation, and secondarily, to create an awareness of the risks of solely relying on technology for patient treatment decisions in lieu of clinical evaluative skills. Timing data were collected from 165 IABP patients from January 1, 2003 to March 31, 2005 using the Datascope series System 97, System 98, and CS100 IABP consoles. Timing criteria used in the evaluation of the IABP in this study included proper inflation, defined as inflation at the dicrotic notch of arterial pressure waveform, and proper deflation, resulting in a presystolic decrease of diastolic pressure by 5-10 mmHg. These parameters were evaluated by examining a printed strip from the IABP console after timing selection stabilization. Before implementation of the CS100, 78.6% of inflations and 53.6% of deflations were correct when using the criteria listed above. After implementation of the CS100, 83.3% of inflations were correct and 44.4% of deflations were correct. Although improvement in consistency of IABP inflation quality was observed, a net decrease in the quality of IABP deflations was also observed. Total reliance on the autotiming operation mode of the CS100 may not be warranted, and imposing clinical judgment in therapeutic application is necessary to avoid dangerous timing errors. An awareness of the dangers of solely relying on technology for patient treatment decisions vs. the use of technology combined with clinical evaluative skills for assessing therapeutic intervention to improve patient care is discussed.
Clinical Perfusion Education Department, School of Allied Health Professions, University of Nebraska Medical Center, Omaha, Nebraska 68198-5155, USA. mosentow@yahoo.com
Melissa K
MK
Osentowski
David W
DW
Holt
D001011:Aorta; D002404:Catheterization / Q000295:instrumentation*; D015908:Counterpulsation; D004867:Equipment Design; D006801:Humans; D007423:Intra-Aortic Balloon Pumping / Q000295:instrumentation*; D013995:Time