Enhanced external counterpulsation in patients with refractory angina pectoris: a pilot study with six months follow-up regarding physical capacity and health-related quality of life.

BACKGROUND: Refractory angina pectoris (AP) is a persistent, painful condition characterized by angina caused by coronary insufficiency in the presence of coronary artery disease. It has been emphasized that there are possible underlying neuropathophysiological mechanisms for refractory AP but chronic ischemia is still considered to be the main problem. These patients suffer from severe AP and cannot be controlled by a combination of pharmacological therapies, angioplasty or coronary bypass surgery. AP has a negative impact on quality of life and daily life. Enhanced external counterpulsation (EECP) is a therapeutic option for these patients. AIMS: The aim of this study was to evaluate EECP after six months regarding physical capacity and health-related quality of life (HRQoL) in patients with refractory AP. METHODS: This was a study with single case research experimental design involving 34 patients treated with EECP. Six minute walk test (6MWT), functional class with Canadian Cardiological Society (CCS) classification and self-reported HRQoL questionnaires as Short Form 36 (SF-36) were collected at baseline and after treatment. CCS class and SF-36 were repeated at six months follow-up. RESULTS: Patients enhanced walk distance on average by 29 m after EECP (p<0.01). CCS class also improved (p<0.001) and persisted at six months follow-up (p<0.001). HRQoL improved significantly and the effects were maintained at follow-up after the treatment. CONCLUSION: Patients with refractory AP receive beneficial effects from EECP both in physical capacity and HRQoL. As other treatment options for this patient group are scarce, EECP should be offered to improve physical health and HRQoL in these patients.

Intervenciones de enfermería al paciente asistido con balón de contrapulsación intraaórtico / Nursing interventions to the patient assisted with intraaortic counterpulsation balloon", "_i": "

El profesional de enfermería que proporciona cuidados al paciente con balón de contrapulsación intraaórtico, también conocido como BIAC, requiere de un perfil acorde a la complejidad de la atención que se proporciona; es decir debe poseer los conocimientos, habilidades y destrezas que permitan proporcionar intervenciones seguras y efectivas en situaciones que ameriten una conducta inmediata y oportuna, sin dejar de lado el aspecto humano a cambio de un cuidado técnico, calificado y ético; éste es un desafío perenne en la recuperación cardiovascular del paciente y las unidades intensivas. Ante este panorama, el presente artículo detalla las intervenciones para el cuidado del paciente que recibe asistencia con balón de contrapulsación intraaórtico, a fin de orientar a los profesionales en su práctica diaria

The nurse who provides care to the patient with intra aortic balloon pump, also known as BIAC, requires a profile according to the complexity of the care provided, i.e. must possess the knowledge, skills and abilities allowing safe and effective interventions in situations requiring immediate and timely conduct, without neglecting the human aspect in exchange for a skilled technical and ethical care; perennial challenge in the patient’s cardiovascular recovery and intensive care units. Faced with this panorama, this article details the care interventions for the patient receiving intra aortic balloon pump assistance, to guide practitioners in their daily practice.

Intervenciones de enfermería al paciente durante la instalación de balón de contrapulsación intraaórtico / Nursing interventions to the patient during the installation of intra-aortic counterpulsation balloon", "_i": "

El balón de contrapulsación intraaórtico (BCIA) es un dispositivo que se utiliza como primera elección en cualquier protocolo de asistencia mecánica circulatoria, ya que proporciona mayor oportunidad de supervivencia en pacientes con insuficiencia coronaria severa. Por su complejidad durante la instalación, el profesional de enfermería debe poseer las competencias específicas y genéricas para proporcionar atención segura y de calidad. Ante este contexto se presenta el siguiente procedimiento como recomendación para el cuidado del paciente adulto durante la fase de instalación del BCIA.

Intra-aortic balloon counterpulsation (IABC) is a device of first choice to patients with ventricular assist providing chance of survival in patients with severe coronary insufficiency. For the complexity during installation, the nurse care needs specific and generic skills to give safe, quality care. Given this context, the following procedure presents a recommendation for adult patient care during the installation of IABC.

Enhanced external counterpulsation: bringing the concept of the intraaortic balloon pump to the outpatient setting.

Enhanced external counterpulsation can now be used in patients with congestive heart failure. As our population ages, we will see more patients with this challenging diagnosis. The authors discuss this exciting treatment.

Enhanced external counterpulsation.

Ischemic heart disease that is refractory or resistant to medical management is a concern to health team members, patients, and their families. These patients are limited in their abilities to perform activities of daily living and often find it difficult to exercise which negatively affects their quality of life. Some patients are confined to bed rest due to these limitations. Enhanced external counterpulsation (EECP) is a noninvasive outpatient procedure that has been shown to improve the patient's quality of life by decreasing ischemic symptoms and permitting increased activity. This article reviews the basic principles of EECP therapy and identifies the goals and benefits for the patient. Helpful tips and observations are discussed as to the use of this treatment using evidence-based research.

Concepts of intraaortic balloon counterpulsation.

The concept of intraaortic balloon counterpulsation (IABC) was developed in the late 1960s, primarily for use in cardiogenic shock. Since that time, many published reports have documented the efficacy of this mechanical assist device in an expanding number of clinical situations. Research has shown that intraaortic balloon counterpulsation increases coronary flow velocity and decreases afterload, thus favorably affecting myocardial oxygen supply and demand. This article offers a review of the concepts and mechanics of IABC, as well as current indications and contraindications for use. The nurse must be able to recognize and address potential complications to ensure positive patient outcomes.

Pulmonary artery balloon counterpulsation as a treatment for right ventricular failure.

Right ventricular failure (RVF) is manifested by a low cardiac output state that is potentially lethal. Pulmonary artery balloon counterpulsation is a means of treating RVF that is refractory to conventional pharmacologic interventions. This treatment is rarely used in isolation but in conjunction with mechanical circulatory support of the left ventricle.

Intra-aortic balloon counterpulsation as a therapy for shock.

As early as 1967, IABC has been effectively used to support patients in cardiogenic shock. IABC provides the temporary circulatory assistance necessary to maintain coronary perfusion pressure, improve stroke volume and cardiac output, and decrease left ventricular preload and afterload. Until new forward flow devices are perfected and become globally available as mechanical assistance for pump failure, the intra-aortic balloon pump will continue to provide temporary mechanical circulatory assistance to support patients in cardiogenic shock until diagnosis of the underlying cause and definitive therapy can be determined.

Intrapulmonary artery balloon pumping after CABG surgery.

Involvement in complex patient care situations is commonplace in critical care settings today. Nurses come in contact with situations in which new techniques and innovative ideas are being implemented. Nursing management can favorably affect the prognosis of the CABG surgery patient with RV failure receiving intrapulmonary artery balloon pumping. Timing should be adjusted to promote pulmonary blood flow and decrease workload of the RV.

Nursing implication for pulmonary artery balloon counterpulsation: a treatment for right ventricular dysfunction after cardiac surgery.

PPRVD is a phenomenon frequently observed in the operating room. Its development can be attributed to a single or many factors associated with cardiac operation. Namely, its presence is precipated by injury to the RV myocardium or changes in the normal hemodynamic functions of the RV. While PPRVD occurs in isolation, it is usually seen with concomitant LV dysfunction. When conventional medical management of LV dysfunction does not improve yet unmasks RV dysfunction, some type of ventricular assist device to support RV dysfunction may be needed to wean patients from cardiopulmonary bypass such as PABC. PABC has been demonstrated to be useful in the management of mild to moderate PPRVD and weaning from CPB. Severe PPRVD has not been demonstrated to benefit from PABC. The major concern in managing PPRVD is the lack of quantifiable criteria for determining levels of RV injury. Research is continuing in this area. Likewise, investigations are under way to develop a transvenous PABC catheter. This catheter would allow for increased PABC use as it would not require surgical placement or removal. The present PABC model could potentially be used in any hospital that uses conventional intra-aortic balloon counterpulsation. The patient presented in this case was cared for in a 350-bed community hospital in the Northeast section of the United States. A PABC patient can present a unique nursing challenge. It is hoped that this article will assist nurses in the future management of these patients.