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Related Experiment Video

Updated: Dec 28, 2025

The Intra-Aortic Balloon Pump
06:13

The Intra-Aortic Balloon Pump

Published on: February 5, 2021

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"Do we have to replace the balloon pump when it fails?"

Trevor M Bibler, Jamie M Crist, Janet Malek

    The Hastings Center Report
    |February 19, 2020
    PubMed
    Summary
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    This case highlights the ethical dilemma of determining decision-making capacity in patients with advanced heart failure. It questions the obligation to continue mechanical circulatory support when a patient may lack capacity.

    Area of Science:

    • Cardiology
    • Medical Ethics
    • Critical Care Medicine

    Background:

    • Patient presented with coronary artery disease and ischemic cardiomyopathy, requiring advanced heart failure support.
    • Initial acceptance for left ventricular assist device (LVAD) was pending cognitive assessment.

    Observation:

    • Patient developed cardiogenic shock, necessitating intra-aortic balloon pump (IABP) placement.
    • IABP dependency and deconditioning occurred within two weeks.
    • Attending physician and medical review board determined lack of decision-making capacity, declining LVAD candidacy.

    Findings:

    • Heart failure and CICU teams recommended terminal weaning of IABP and comfort care.
    • Family disagreed, citing patient's continued engagement and eating.

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  • Ethical impasse reached regarding continued mechanical support.

    • Implications:

    • This case underscores the complexities in assessing patient capacity for medical decisions in critical care settings.
    • It raises questions about the ethical obligations of healthcare providers when faced with conflicting views between medical teams and families.
    • The scenario prompts a discussion on the balance between aggressive treatment and patient-centered comfort care in advanced heart failure.