Transfer of patients dependent on an intra-aortic balloon pump using critical care services

The intra-aortic balloon pump (IABP) is a hemodynamic support device that provides circulatory enhancement to patients whose cardiac output is compromised. Special clinical skills are required for management of the patient with an IABP in place. Few studies have discussed the transport of the IABP-dependent patient. The current study was designed to describe the transport of IABP-dependent patients, with a focus on pretransport interventions, transport interventions, quality improvement, and complications.

A review of all transports from January 1, 2004, through December 31, 2005, performed by a critical care transport program with a nurse/paramedic crew offering mobile intensive care unit (ICU), rotor-wing, and fixed-wing service was conducted. All patients who were maintained on an intra-aortic balloon pump (IABP) were eligible for inclusion. A certified perfusionist was available for consultation on all transports. Information about the IABP, including the pump timing, confirmation of balloon location, and inflation/deflation timing parameters, was collected. Proper balloon placement was verified and recorded at the sending hospital. Data were collected regarding interventions required before and during transport and complications during transport. Descriptive statistics were used.

During the study period, 173 transports involving an IABP were performed. The average age was 60.8 years, and 67.8% were men. Forty-one percent were flown by rotor-wing, 36.4% were transported by the mobile ICU, and 21.4% were flown by the fixed-wing transport. In 1.2% of cases, there was a change in transport mode. Twelve percent of patients required some increase in oxygen supplementation, but only one patient required intubation before transport by the transport crew. The most common pretransport medications were heparin (69%), inotropes (55%), and other infusions (46.8%). Twenty-two percent had no written confirmation of the correct balloon placement. There were no significant complications found during transport, including hemorrhage, loss of trigger signals, or cardiac arrest. Twelve percent had some abnormalities in timing of balloon inflation or deflation.

IABP transports can be safely performed by a nurse/paramedic critical care transport team with perfusionist consultation. Few patients require significant intervention before transport. Attention must be paid to balloon inflation and deflation timing despite the existence of timing algorithms. Significant complications during transport were not seen. Future studies should explore the overall outcome of IABP-dependent patients and the role of transport mode on outcome.