Key result
tPA injection or forceful extraction manages IABP entrapment after ~10 days of use.
Why the study?
How should entrapped intraaortic balloons be managed to prevent vascular complications?
Case Report (n=2)
No
How should entrapped intraaortic balloons be managed to prevent vascular complications?
Injecting tissue plasminogen activator into the drive lumen of an entrapped, clot-filled intraaortic balloon may facilitate safe removal and prevent severe vascular injury associated with forceful extraction.
Entrapped intraaortic balloon removal risks vascular injury; Level 5 evidence leaves open whether tPA thrombolysis enables safer extraction.
A review of intraaortic balloon pump use at the University of Miami/Jackson Memorial Medical Center over the past 21 years identified 2 cases where a balloon was found to be entrapped. The balloon catheters had been in place for approximately 10 days when this complication occurred. The retained balloons were torn, filled with clotted blood, and impacted in the vasculature. In our first case, forceful removal of the intraaortic balloon was complicated by unintentional extraction of the external iliac and common femoral arteries. In the second case, clot within the balloon was dissolved with tissue plasminogen activator injected into the drive lumen of the catheter before removal. The prevention and management of this rare but serious complication of intraaortic balloon pumping is reviewed.
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Horowitz et al. (1993) conducted a case report in Intraaortic balloon entrapment (n=2). Intraaortic balloon pump was evaluated on Intraaortic balloon entrapment and management. Intraaortic balloon entrapment occurred in 2 cases after approximately 10 days of use, managed by forceful removal causing arterial damage in one and tPA injection before removal in the other.
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