UMEM Educational Pearls

Category: Critical Care

Title: Intra-aortic balloon pump counterpulsation

Keywords: intra-aortic balloon pump counterpulsation, cardiogenic shock (PubMed Search)

Posted: 4/29/2008 by Mike Winters, MBA, MD (Updated: 5/27/2024)
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Intra-aortic balloon pump counterpulsation

  • It is possible that at some point in your career you may need to place an intra-aortic balloon pump (IABP) to temporarily stabilize a patient wth cardiogenic shock
  • Optimal performance of the IABP is dependent upon proper positioning in the thoracic aorta
  • Traditional teaching has been to insert the IABP via the femoral artery and advance to the level of the aortic knob (via CXR)
  • A recent study suggests that using the aortic knob to position the IABP may result in occlusion of the left subclavian artery in a substantial portion of patients (16% in the study)
  • Placing the IABP 2 cm above the carina may be a more reliable landmark that using the aortic knob


Kim JT, Lee JR, Kim JK, et al. The carina as a useful radiographic landmark for positioning the intra-aortic balloon pump. Anesth & Analg 2007;105:735-8.