An intra-aortic balloon pump (IABP) is an electrocardiogram (ECG)
synchronized endovascular balloon that inflates in the proximal
descending aorta (Figure 40-1) during cardiac diastole, acting both
to augment coronary perfusion and cardiac output, and deflates during
systole, permitting cardiac ejection.
Definitions and Terms
- ▪ Counterpulsation: Rhythmic mechanical pumping synchronized
with the heartbeat.
- ▪ Systole: The phase of the heartbeat during which cardiac
muscle contracts actively ejecting blood through the open aortic
- ▪ Diastole: The phase of the heartbeat during which the left
ventricle fills with blood from the left atrium through the open
mitral valve, and during which the majority of coronary perfusion
- ▪ Indications:
- —Unstable angina
- —Cardiogenic shock
- —Cardiac insufficiency following cardiac surgery
- —Mechanical cardiac support in the setting of certain
cardiac lesions such as acute mitral insufficiency or intracardiac
- ▪ Contraindications:
- —Aortic dissection
- —Aortic insufficiency
- —Severe atherosclerotic disease of the aorta
- —Aortic aneurysm
- —Aortic graft
- ▪ Prior to procedure, obtain patient consent, prep and
drape, and perform universal protocol as described in Section I.
- ▪ The IABP is almost invariably placed through one of the
- ▪ Preparation:
- —Skin: The Center for Disease Control and Prevention
(CDC) recommends preparation of the cannulation site with a 2% aqueous
chlorhexidine-gluconate solution, which has been associated with
lower blood stream infection rates than povidone-iodine or alcohol-based
preparations. The skin and tissue around the vessel should be infiltrated
with 1% lidocaine solution, except in patients with a known
allergy to lidocaine, in whom alternative local anesthetics can
- —Hygiene: The operator should observe proper hand-hygiene
and use maximal barrier precautions including gown, mask and gloves,
and a large sterile drape or multiple drapes covering a large area.
- ▪ Methods (see Chapter 34 on vessel cannulation):
- —Direct cannulation.
- —Seldinger technique is used as an adjunct for catheter
exchange with either of the above cannulation techniques.
- —Ultrasound guided vessel location can be used for
- ▪ Following access to the vessel, the IABP is inserted
to a premeasured depth so as to lie in the proximal descending aorta
(Figures 40-2, 40-3, 40-4, and 40-5).
- ▪ Balloon inflation is timed to occur during diastole, and
gated to the ECG or arterial pulse wave (Figure 40-6).
- ▪ The pumping ratio is typically 1:1, although it may be
reduced to 1:2 and/or 1:3 prior to removal.
- ▪ A confirmatory chest x-ray is used to identify the location
of the tip of the balloon.
- ▪ Complications are varied, and include:
- —Leg ischemia or compartment syndrome
- —Aortic dissection
- —Embolization of debris to the brain and/or