Arrow AutoCAT 2 Series Operating Manual page 16

1 . C l i n i c a l U s e s
1 . 1 : C l i n i c a l U s e s o f I A B P
Cardiac Contusion 26
Contusion with subsequent infarction of the myocardium can occur with trauma to the
chest wall. The majority of cases of myocardial contusion result from automobile acci-
dents and other blunt chest trauma. Aneurysms involving the contused area can occur.
The necrosis of contused cardiac tissue is very similar to infarction from Coronary
Artery Disease (CAD). The acute phase of contusion is characterized by hemodynamic
instability, and cardiogenic shock is not uncommon in severe cases. These patients
benefit from IABP in much the same way that patients with cardiogenic shock caused by
a coronary event benefit from IABP. However, many patients with cardiac contusion are
young and without coronary disease. The infarction involves a discrete area and is much
less diffuse than infarction caused by coronary obstruction. The long-term prognosis is
far better in patients with necrosis caused by contusion if they survive the acute phase.
IABP is indicated if conservative measures do not restore hemodynamic stability.
Support and stabilization of High risk patients undergoing diagnostic and
Non-surgical procedures 3,8,12
Patients undergoing ischemic events are sometimes candidates for cardiac
catheterization, coronary angioplasty, stents, thrombolytic therapy or coronary
atherectomy. Cardiac catheterization is necessary to identify the obstructed arteries
that may be successfully treated by coronary bypass surgery. In hemodynamically
unstable patients, the catheterization procedure can be hazardous because coronary
artery supply is temporarily interrupted during injection of the radio opaque dyes. This
interruption of the already inadequate oxygen supply can precipitate sudden
deterioration of myocardial functions. Use of IABP increases the probability that
angiographic studies can be completed in a controlled manner.
Coronary angioplasty may be contraindicated in a hemodynamically unstable patient
with an otherwise correctable lesion. Inflation of the angioplasty balloon temporarily
obstructs coronary blood flow. The use of IABP may help to stabilize the patient's
hemodynamic condition and increase coronary reperfusion by increasing CPP.
In addition, studies have shown that IABP use after emergency or high risk primary
PTCA for acute MI reduces reocclusion and may add strength to reperfusion and
improvement of LV function 10,14,15,22 .
Coronary atherectomy may be indicated in specific types of coronary lesions. IABP may
support this interventional procedure .
24
Medical Indications
1-6