Q: 58 years old male with cardiogenic shock and on intra aortic balloon pump (IABP), became pulseless in ICU. 'Code' is called, and CPR is started. IABP should preferably be on? (select one)
A) "standby" mode
B) "ECG trigger" mode
C) "Pressure trigger" mode
D) immediately withdraw/discontinue
Answer: C
If a patient on IABP requires CPR, it should not be discontinued (choice D). It should be switched to "pressure trigger" (choice C). IABP is usually on "ECG trigger" by default to synchronize with the systole and diastole of the heart.
IABP during CPR is actually helpful. It improves cerebral and cardiac blood flow.
With CPR, on "pressure trigger," an arterial pressure tracing should be generated on the console/screen. If the console is not recognizing the arterial pressure tracing, chest compressions may not be adequate.
If the bedside staff needs clarification or is uncomfortable regarding IABP during code, it can be switched to 'standby' mode (choice A), but it is not a recommended setting.
#procedures
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#cardiology
Further reading:
1. Unverzagt S, Buerke M, de Waha A, Haerting J, Pietzner D, Seyfarth M, Thiele H, Werdan K, Zeymer U, Prondzinsky R. Intra-aortic balloon pump counterpulsation (IABP) for myocardial infarction complicated by cardiogenic shock. Cochrane Database Syst Rev. 2015 Mar 27;2015(3):CD007398. doi: 10.1002/14651858.CD007398.pub3. PMID: 25812932; PMCID: PMC8454261.
2. Buckley AJ, O'Connor C, Fitzgerald S, Hennessy T, Kiernan T. Mechanical Chest Compressions and Intra-Aortic Balloon Pump Combination for Refractory Ventricular Fibrillation During Primary PCI. JACC Case Rep. 2022 Mar 16;4(6):364-369. doi: 10.1016/j.jaccas.2022.01.018. PMID: 35495556; PMCID: PMC9040123.
3. Osborn C, Quaal SJ. Maximizing cardiopulmonary resuscitation in patients with intra-aortic balloon pumps. Crit Care Nurse. 1998 Apr;18(2):25-7. PMID: 9708117.
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