The money that poured in from GE let us equip the ICU with equipment that few hospitals in the US had, let alone a smallish one in Alaska. One thing we acquired was this:
Its a intra-aortic ballon pump. It's the second series of those built by Datascope, and it's cost in 1975 was around 100K. I'll let you do the math to figure out what that is in 2014 bucks.
The primary goal of intra-aortic balloon pump (IABP) treatment is to increase myocardial oxygen supply and decrease myocardial oxygen demand. It is used for those patients in critical condition with 'pump failure'.
To understand why it works a short review is in order.
The heart has two basic phases in it's function of delivering oxygen-enriched blood to the body, and sending the blood after being circulated back to the lungs to be re-oxygenated. The phases are systole and diastole.
The heart muscle is supplied with oxygenated blood during the diastolic cycle. The purpose of the IABP is to augment the blood delivered to the muscle, and hence reduce the workload, ergo demand.
The method used then has been considerably refined, but then a large diameter catheter was placed in the femoral artery via a cut-down in the groin, then threaded up to just below the aortic arch.
The catheter end was then attached to the tube seen on the arm above the Datascope. During diastole the balloon would inflate briefly, pushing the blood back up the aorta and into the coronary arteries, thus augmenting the supply of oxygen the heart muscle was getting.
Enlarged, the picture shows a aortic pressure waveform, and the augmentation achieved.
The tricky part then, once the placement had occurred, was timing the inflation of the balloon at the end of the catheter to match the diastolic period. It was measured in milliseconds, and had to be monitored constantly and adjusted when the heart rate changed. Since that time the device has been computerized and automated, but back then one of the 4 of us working on the project had to be there 24/7. A inflation during systole could be disastrous. It also had complications...after a period of time the constant inflation of the balloon would beat up the platelets, reducing the red cells.
It was fun, the four of us were all young turks. One is now the chair of a department at a university, another a cardiologist in Kentucky, the other was the head of anesthesia at a major southern California medical center before retiring. The last is retired, and spends his time reminiscing and fishing.
Here's to everyone who achieves retirement, reminiscing and fishing.
ReplyDeleteHere's to that.
DeleteIn between our gardening, fishing, and doing crossword puzzles it's good to remind ourselves of the things we've accomplished - some of them, like yours, pretty darn noteworthy.
ReplyDeleteI was part of a team that did it, and it was fun.
DeleteWell that's set me up nicely for my evening shift on icu tonight
ReplyDeleteI always preferred the evening shift, it missed the agony of rounds, were every resident within shouting distance was trying to prove they had something to say.
DeleteAlso it's better than the 'pit', the ER.
Hmm, the docs I worked with at OHSU developed the TIPS procedure in 1969. They gave me a book about the Dotter Institute rather than a bonus one Christmas. I left it in the cupboard when I retired.
ReplyDeleteI'm sure I would have felt very different had I been an originator. That was good work you did.
Hey Susan
DeleteOHSU has seen a bunch of ground-breakikng things. Do you know the first 'forward angiography' was done just down the hill at the VA by docs from the OHSU program? Hand made catheters, etc.
It was fun, we all stand on somebody's shoulders, eh?
As one who owes his life to such machines, I find this sort of descriptive history --especially from your own involvement-- absolutely fascinating.
ReplyDeleteAh, be interested to know more about your time under my brethren's care.
DeleteMostly I do these kind of posts to try to maintain knowledge, which I find is slipping away, and to convince myself that I once did stuff.
The whole process kind of reminds me how the valves work in an internal combustion engine. It sounds like an interesting and challenging project, that the four of you were working on. It seems you've ended up in a pretty good place, these many years later.
ReplyDeleteI would like to have that Ford Ranchero and GTO (I think) sitting next to it in your first photo.
I think it might well be a goat, great car but not what is best for winter up there. I had a Land Cruiser and it stayed in 4WD for 6 months of the year.
ReplyDelete