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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
References
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.