Intra-aortic balloon counterpulsation73
Intra-aortic balloon counterpulsation or intra-aortic
balloon pumping (IABP) involves the percutaneous
insertion of a balloon device into the descending aorta.
The balloon is inflated during diastole and deflated
during systole to reduce systolic afterload and increase
diastolic perfusion pressure, thereby augmenting cardiac
output and coronary blood flow.
The balloon catheter is usually inserted into the aorta
via a femoral artery, so that the tip is positioned just
below the level of the left subclavian artery (Figure 4).
This is achieved by preparing and draping the patient
and laying the balloon on the patient’s chest and
abdomen 1 cm below the angle of Louis and noting the
level where the balloon would exit the femoral artery.
The device is then inserted percutaneously under local
anaesthesia using a Seldinger technique.74 Heparin
anticoagulation is optional (e.g. not included in the
presence of a coagulopathy or recent surgery, but is
often used if the balloon compromises the circulation to
the lower limb).