CLINICAL APPLICATION OF THE INTRAAORTIC BALLOON PUMP. 3rd revised edition. Hooshang Bolooki. 470 pp. Illust. Futura Publishing Company, Inc., Armonk, NY. 1998. US$98. ISBN 0-87993-401-8
More than 14 years have passed since the publication of the second edition of this book. Its main purpose is to describe the function and clinical applications of the intraaortic balloon pump (IABP) in various clinical conditions, to review the new achievements and complications of the IABP and to present a basic description of the physiology of balloon pumping and cardiac dysfunctions. This book was written to serve as a text and reference source rather than as a manual or quick guide on how to set up and run the device. It is intended for members of the multidisciplinary team, including cardiac surgeons, cardiologists, clinical physiologists (intensivists), technologists, perfusionists and critical care nurses.
The book is divided into 5 sections comprising multiple chapters. In the first 2 sections the author presents an accurate description of the contemporary principles of assisted circulation, cardiac function and pathophysiology of cardiac failure and cardiogenic shock. These 2 sections are not meant to be an exhaustive discussion of the basic physiologic principles and clinical features of cardiac failure. They do, however, present a clinical classification of failure, supported by schematic diagrams, and a good discussion on the clinical applications and predicted value of a shock box, well illustrated by hypothetical patient scenarios.
In the third section, which covers 186 pages, the author provides complete reviews of the historical background, the balloon pump equipment and consoles and catheters. A chapter on the physiology of balloon pumping is the most exhaustive one in the book and covers the topic in detail supported by excellent diagrams and electrocardiographic rhythm strips. A chapter on insertion and removal of the IABP catheter includes an interesting review of the author’s experience since 1978 and presents different techniques (percutaneous and surgical). There are also chapters on contraindications and guidelines for the use of balloon pumping and finally a detailed, well-written chapter on the complications of intra-aortic balloon pumping.
The fourth section covers the management of patients on the IABP, including nursing care, hemodynamic monitoring and data acquisition, pharmacologic treatment, weaning strategies and management of other organ systems while the IABP is in use. This well-written section also contains concentration charts for commonly used “drips” in cardiac surgery, a table of normal values for hemodynamic measurements, a table that shows the basic pharmacokinetic effects of various pressure agents commonly used in patients on the IABP and a review of problems and troubleshooting strategies. The interesting final chapter in this section addresses contemporary issues of cost effectiveness, and ethical and legal considerations.
The last section contains an indepth review of the indications for the use of the IABP in both adult and pediatric populations, including standby, and electrical and emergency indications. There is also a discussion of miscellaneous indications such as cardiac transplantation and intrapulmonary balloon pumping. With the exception of the final section, which is poorly identified, and chapter 20 “an overview,” which is mistitled as “Indications for use of intra-aortic balloon pump,” this book is well written and well organized. It should be welcome as a reference text to the libraries of multidisciplinary teams caring for cardiac patients.