How can a patient be weaned from an intra-aortic balloon pump (IABP)?

  • There are two primary options for weaning from IABP
Reducing Augmentation Ratio
  • Ratio of augmented to non-augmented beats can be reduced from ratios of 1:1 to 1:2 to 1:3
  • The timing of augmentation reduction is usually every 1-6 hours depending upon the individual clinical picture
  • If a ratio of 1:3 is tolerated for 6 hours then the device should be removed
Reducing Augmentation Volume
  • Volume of balloon augmentation can be decreased by 10ml until a lower limit of 20ml is reached
  • Again, the timing of volume reduction is usually every 1-6 hours depending upon the individual clinical picture
  • If an augmentation volume of 20ml is tolerated for 6 hours then the device should be removed
  • The risk of thrombus formation increases as the augmentation ratio or volume is decreased
  • The balloon pump must not be left in situ once switched off as this is associated with a high chance of thrombus formation on the balloon and distal embolization
  • Systemic anticoagulation should be corrected before removal of the catheter