From the Guidelines
Proper intra-aortic balloon pump (IABP) placement on chest X-ray should show the radiopaque tip of the catheter positioned 2-3 cm distal to the origin of the left subclavian artery, typically at the level of the carina or the aortic knob (aortic arch). When considering IABP placement, it is crucial to weigh the benefits against potential contraindications, such as severe aortic insufficiency and advanced peripheral and aortic vascular disease, as noted in the clinical review by 1. Key considerations for IABP placement include:
- The balloon itself should be located in the descending thoracic aorta, extending above the level of the diaphragm but below the left subclavian artery origin.
- Improper positioning can lead to serious complications, such as occlusion of the left subclavian artery or carotid arteries if placed too high, or blockage of the renal or mesenteric arteries if placed too low.
- Proper inflation and deflation of the balloon should be visible on sequential X-ray images, indicating effective counterpulsation to increase coronary perfusion and decrease afterload, as described in the management of perioperative heart failure in cardiac surgery by 1. The IABP's mechanism of action, including reduction of afterload and increased diastolic coronary perfusion via electrocardiogram triggered counterpulsation, makes it an ideal application in postcardiotomy cardiac dysfunction, especially in suspected coronary hypoperfusion, as discussed by 1.
From the Research
Proper IABP Placement with X-ray
To determine the proper placement of an intra-aortic balloon pump (IABP) using X-ray, it is essential to consider the positioning of the catheter in relation to the patient's anatomy.
- The IABP catheter should be placed in the descending aorta, just below the origin of the left subclavian artery 2.
- A balloon placed too high can block off the arch vessels, whereas one placed too low can block the renal and splanchnic vessels 2.
- The use of X-ray can help verify the correct positioning of the IABP catheter, ensuring that it is not too high or too low in the aorta.
Alternative Approaches to IABP Insertion
While the femoral artery is the most common approach for IABP insertion, alternative approaches have been explored, including:
- Subclavian artery insertion, which can provide a minimally invasive approach to mechanical support and facilitate ambulation in patients with end-stage heart failure 3, 4, 5.
- External iliac artery approach, which can be used as a bridge to cardiac transplantation in patients with chronic heart failure 6.
X-ray Verification of IABP Placement
X-ray can be used to verify the correct positioning of the IABP catheter, ensuring that it is:
- Below the origin of the left subclavian artery
- Above the renal arteries
- Not blocking any major vessels
- Properly positioned in the descending aorta 2.