Slide 1: What is the labeled object on this chest radiograph?

Slide 2: This is an intra-aortic balloon pump (IABP). Is it in the right position? what is it used for? Why does it work?

Slide 3: Is it correctly positioned? Ensuring the tip is within the center of the circle made by the aortic arch can serve s a heuristic to confirm placement.

The radio-opaque tip of the IABP should be adjacent to the inferior aspect of the aortic arch, or approximately 2 cm above the carina. This positioning is in order to prevent occlusion of the left subclavian (if too high, causing acute limb ischemia) or renal arteries (if too low, causing AKI).

Slide 4: IABP mechanics. The balloon pump operates on the principle of counter-pulsation. The pump inflates during diastole which increases coronary artery perfusion pressure, thus improving myocardial oxygen supply.

The pump deflates during systole which reduces afterload and augments cardiac output, thus reducing myocardial oxygen demand.

Use is indicated for temporary cardiac support in two categories: augmentation of LV function (cardiogenic shock) and reduction in myocardial ischemia

Slide 5: IABP indications and contraindications.

Indications. Augmentation of poor LV function. Cardiogenic shock, acute severe MR, myocardial injury, peri-cardiac surgery. Reduction in myocardial ischemia. Acute MI, high risk coronary anatomy pending intervention, refractory or high risk angina, refractory ventricular arrhythmia, peri-cardiac surgery.

Contraindications. Absolute. Aortic regurgitation, aortic dissection, end-stage disease without expectation of recovery. Relative. Aortic aneurysm, severe PAD, uncontrolled bleeding, uncontrolled sepsis, tachyarrhythmia.