Management of Intra-Aortic Balloon Pump Entrapment: A Case Report and Review of the Literature

An intra-aortic balloon pump is one of the most valuable tools in the cardiac surgeon''s armament to assist in the management of the failing heart. Despite its widespread use, there are associated risks and complications, one of which is balloon rupture with associated entrapment. Numerous approaches for dealing with this complication have been described; here we review the previous experience with intra-aortic balloon pump entrapment and discuss potential management, with particular reference to a recent case of our own.Key words: Assisted circulation/adverse effects, counterpulsation/mortality, entrapment, intra-aortic balloon pumping/adverse effects/methods/mortality/rupture/standards/statistics & numerical data, risk assessmentCardiac surgery offers myriad interventions for possible use in an aging population that has a high prevalence of heart disease. This abundance of options has led to more complex cardiac surgery and to higher public expectations of successful outcomes.¹ Against this background, any mechanism that facilitates survival is welcome.The intra-aortic balloon pump (IABP), first used by Kantrowitz in 1967 in a patient with cardiogenic shock, provides mechanical cardiac support via insertion of an inflatable balloon into the descending aorta; it is the most commonly used supportive tool for temporary cardiac assistance.^1,2 The IABP works by reducing afterload and actively increasing coronary perfusion.² The indications are varied but include ongoing ischemia refractory to medical therapy, a need for prophylaxis in high-risk patients before cardiac surgery, and postoperative ischemia and low cardiac output despite inotropic support.³Intra-aortic balloon pump use, although priceless in improving postoperative survival in high-risk cardiac surgical patients and those with ventricular dysfunction, is not without risks.^1,2 Balloon rupture, aortic or iliac artery dissection, thromboembolism, distal ischemia, and thrombocytopenia due to the mechanical action of the balloon on platelets are all potential complications of IABP use.^1,4 Despite these risks, there are over 70,000 insertions annually in the United States alone. Of all cardiac surgical patients, 5% to 10% undergo IABP placement.⁵Intra-aortic balloon pump rupture with associated entrapment of the balloon within the arterial tree is very rare. Because numerous approaches to deal with this complication have been described, we review the previous experience and discuss the potential management of IABP entrapment, with specific reference to a case of our own.