1. 2nd Edition / 2002
The information contained on the following pages, in conjunction with the slides provided at the back of this binder, complete the Introduction to Intra-Aortic Balloon Pumping Slide Series.
This information is to be used as a teaching guide and is not intended nor implied to be Instructions for Use. Additional information on the enclosed procedures and products may be obtained by calling
All information and slides are the property of Arrow International and cannot be copied or reproduced without written permission of Arrow International.
© 2002 Arrow International

2. The intra-aortic balloon (IAB) is a Volume Displacement Device
Balloon inflates and occupies space equal to it’s size, displacing blood volume superiorly and inferiorly, increasing diastolic pressure
Balloon deflates causing a rapid drop in thoracic aortic volume causing a decrease in aortic pressure (afterload)
Balloon is positioned in the descending thoracic aorta
2cm below the origin of the left subclavian artery
Above the renal arteries
Balloon Occlusivity
Should occlude aorta % when inflated
Total occlusion can increase risk of aortic wall trauma, damage to red blood cells and platelets, and increases risk of IAB abrasion
Occlusivity can be estimated via balloon pressure waveform assessment
The plateau pressure of the balloon pressure waveform should be within 20 mmHg +/- of the Peak Diastolic Pressure
“Inflation increases Supply – Deflation decreases demand”
Benefits of Inflation
Increase in diastolic pressure, increasing coronary artery perfusion pressure and blood flow
Increased diastolic pressure also increases perfusion to distal organs and tissues
Potential for improved coronary collateral circulation
Increased systemic perfusion
Benefits of Deflation
Decreased aortic end diastolic pressure resulting in a reduced afterload
Decreased cardiac workload by lowering the pressure the left ventricle has to generate to eject
Shortened the IVC phase reduces myocardial oxygen demands
Increased stroke volume occurs as a result of decreased afterload, allowing the heart to empty more efficiently
Enhanced forward cardiac output can occur in cases of shunting such as ventricular septal defect and mitral valve insufficiency

3. Timing
To create the desired hemodynamic effect, the inflation and deflation of the IAB must occur at the appropriate time in the cardiac cycle.
This is referred to as ‘timing the balloon’.

4. How is proper timing achieved?
Always performed using the arterial pressure waveform as the guide
Proper timing is essential to achieve the hemodynamic effects of increased coronary artery perfusion and decreased workload
When timing the intra-aortic balloon pump, assessment of the arterial pressure waveform must occur since the action of the IAB alters the pressure gradients in the arterial vasculature.
The pump must be set on a 1:2 ratio for proper assessment, meaning one balloon-assisted beat for every other patient beat.

5. Arterial Pressure Waveform
PSP
75% SV
25% SV DN
AVO
IVC X
AEDP
Arterial Pressure waveform reflects the pressure changes in the arterial tree.
Aortic Valve Open (AVO), onset of ‘dynamic’ systole (blood moves out of ventricle into vasculature).
Peak Systolic Pressure (PSP), the highest pressure during systole, reflects left ventricular work.
Dicrotic Notch (DN), signifying aortic valve closure (end of systole) and the beginning of diastole.
Isovolumetric Contraction (IVC), closure of mitral valve (end of diastole) and the beginning of ‘static’ systole (increasing ventricular pressure to overcome aortic pressure to open aortic valve for systemic perfusion.

6. Arterial Pressure Waveform
Without IABP
With IABP
Assist 1:2
Comparison of arterial pressure waveform without IABP effect to one with an IABP on 1:2 assist.
It’s important to remember that the arterial trace reflects the changes in vascular pressure that has occurred as a result of cardiac activity.
With an IAB in place, we alter these pressures through IAB inflation and deflation.

7. PSP APSP DN PAEDP BAEDP Augmentation Peak Systolic Pressure Assisted
Dicrotic
Notch
Patient
Aortic
End
Diastolic
Pressure
Arterial pressure waveform landmarks with 1:2 assist
Patient Aortic End Diastolic Pressure (PAEDP), reflects lowest pressure in the aorta at the end of diastole, without IABP effect
Peak Systolic Pressure (PSP), reflects LV work, the pressure the ventricle has generated, without IABP effect
Augmentation (AUG), also referred to as Peak Diastolic Pressure (PDP), reflects the increase in vascular pressure as a result of IAB inflation
Balloon Aortic End Diastolic Pressure (BAEDP), reflects the decrease in vascular pressure prior to the next systole, caused by IAB deflation
Assisted Peak Systolic Pressure (APSP), reflects the decrease in LV work as a result of decreased afterload
Dicrotic Notch (DN), reflects closure of the aortic valve, the onset of diastole
Balloon Aortic End Diastolic Pressure

8. Assist Ratios 1:1 1:2 1:4 Refers to how often the IAB inflates
1:1 assisting every beat
1:2 assisting every other beat; used for timing assessment and weaning.
1:4 assisting every fourth beat; used to wean
1:4

9. Correct Inflation Just prior to DN DN DN Rule 1:
Inflation should occur just prior to the onset of the appearance of the dicrotic notch
(accounts for the time delay inherent in fluid filled transducers and monitoring systems)
Result should be a sharp ‘V’ between 1st and 2nd peak
AUG should be higher than the PSP
There should be no evidence of dicrotic notch and the inflation should not be more than one to two ‘small boxes’ above the level of the dicrotic notch (when printed on graphed recorder paper).

10. AUG should be higher than PSP
Unless:
Patient’s SV significantly greater than balloon volume
Balloon is positioned too low
Hypovolemia
Balloon is too small
Low SVR
Improper timing
Partial obstruction of gas flow
AUG
PSP
The greatest rise in augmentation (peak diastolic pressure) occurs when the volume displaced by the IAB more closely approximates the stroke volume (SV) of the left ventricle.
The patient with a cardiac output of 4L/min at a HR of 100 would have the best rise in PDP. If CO = HR x SV, then 4000cc = 100 x ‘SV’; SV = 40cc. Patient with a CO of 5.5 L/min at a HR of 80 has a SV of approx 70cc and may not have a PDP higher than PSP. This might be the prophylactic IAB, eg pre-op.
If the IAB is too far away from the ventricle.
Hypovolemia- need to have some SV to displace back to the heart. This might be the immediate post-op heart.
If the IAB is less than 85% occlusive, the SV will just run by the sides of the IAB.
With a low SVR, the ‘energy’ of inflation is absorbed by compliant aortic walls.
Late inflation, most of the blood to be displaced has already begun to perfuse the periphery.
Anything that slows down the speed of inflation (partial kinking of the gas line tubing, etc).

11. Correct Deflation BAEDP < PAEDP APSP < PSP PSP APSP PAEDP BAEDP
Rule 2
BAEDP is lower than the PAEDP, reflects that the balloon has deflated before the aortic valve opens
Rule 3
APSP is lower than the PSP, reflects the reduction in LV work related to balloon deflation during the IVC phase, decreasing afterload
PAEDP
BAEDP

12. Poor afterload reduction
May be caused by:
Balloon not large enough or not filled to full volume
Compliant aortic wall
Improper placement
Partial obstruction of gas flow
PSP
APSP
PAEDP
BAEDP
A compliant aortic wall is reflective of an already decreased afterload
IABs placed too low alter pressures too far away from the pressure source to affect LV work
Any obstruction to rapid deflation decreases benefit

13. Timing Errors Early Inflation Late Inflation Early Deflation
Late Deflation

14. Early Inflation Early Inflation
Inflation has occurred well before dicrotic notch would have appeared (aortic valve closure)
Hemodynamic effect
Premature closure of aortic valve
Decreased stroke volume / CO
Compromised stroke volume adds to the next beat’s preload
Increased preload causes an increase in left ventricular wall tension, the single most determinant of myocardial oxygen consumption

15. Early Inflation Correct Timing AUG DN move inflation
Correcting early inflation
Move inflation control to the right until inflation is not more than 40msec prior to the level of the dicrotic notch, which is seen after the APSP
Correct Timing

16. Late Inflation Late Inflation
Diastole has already started, stroke volume is running by the IAB and then the balloon is inflated
This is indicated by the presence of the dicrotic notch between the PSP and the AUG
Hemodynamic effect - late inflation
AUG (diastolic augmentation) less than optimum
Sub-optimal increase in coronary perfusion

17. Late Inflation Correct Timing AUG DN move inflation
Correcting late inflation
Move inflation to the left until the AUG just covers the dicrotic notch, creating a sharp V shape between the first and second peaks
AUG height should also improve
Correct Timing

18. Early Deflation Early Deflation
The balloon has deflated during diastole
The aorta has time to fill back in with blood and pressures go back to unassisted levels
Violates rule # 3 because APSP = PSP
Hemodynamic effect - early deflation
Pressure in the aorta has already equilibrated back to baseline; the ventricle is ejecting against unassisted levels
No afterload reduction
No decrease in cardiac workload and myocardial oxygen consumption (MVO2).

19. Early Deflation Correct Timing move deflation PSP APSP
Correcting early deflation
Move deflation to the right until APSP is less than PSP
The BAEDP will become more ‘V’ shaped
Correct Timing

20. Late Deflation Late Deflation
The balloon remains inflated when left ventricular ejection is occurring
The ventricle is now ejecting against a higher pressure
Violates rule #2 since the BAEDP is higher than the PAEDP
Hemodynamic effect - late deflation
Increased workload to the left ventricle and increased MVO2
Possible decreased Cardiac Output and increased PCWP

21. Late Deflation Correct Timing BAEDP PAEDP move deflation
Correcting late deflation
Move deflation to the left until BAEDP is less than PAEDP
Correct Timing

22. The AutoCAT® 2 series consists of 2 pumps, the AutoCAT® 2 and the AutoCAT® 2 WAVE™. Both pumps have the full range of AutoPilot™ and Operator mode features. The AutoCAT® 2 WAVE™ pump incorporates the Fiber Optic technology of the LightWAVE™ IAB Catheter and the WAVE™ inflation timing algorithm.

23. This is an intra-ventricular pressure-volume loop obtained by an LV Conductance catheter attached to a P_V loop machine made by CD Leycom. The top left trace reflects intraventricular volume changes and the second trace reflects pressure generated by the LV. The third trace demonstrates how even rapid unpredictable arrhythmias can be successfully triggered and pumped using a fiberoptic catheter.
Example of a patient on the IABP with WAVE™ inflation timing and R-WAVE™ deflation timing. The last line of waveforms shows the AP tracing. The patient was NYHA class II, EF 25%, during off-pump CABG. The HR varied between bpm with significant changes in pulse pressure.
NYHA class III patient, EF 25%, during off-pump CABG. HR varied between bpm with significant changes in Pulse Pressure on a beat to beat basis.

24. AutoPilot™ Mode
Automatically selects the best available ECG source / lead
Automatically selects the AP source
Automatically selects the appropriate trigger mode
Automatically selects the optimal timing method and settings
AutoPilot™ Mode features:
Automatically selects the best available ECG source/lead
Automatically selects the AP source
Automatically selects the appropriate trigger mode
Automatically selects the optimal timing method and settings.

25. Operator Mode Clinician selects: ECG source / lead AP source
Trigger mode
Timing settings
Operator Mode:
The user is responsible for changing the ECG source/lead as needed, changing AP source as needed, changing the trigger mode as needed, and setting the timing.

26. Both Modes Automatically adjust ECG gain
Unless manual gain function selected
Automatically selects AP scale
Unless manual scale function selected
User can select ECG source / lead and AP source
Both Modes of operation:
Adjust the ECG gain to maintain triggering.
Select the AP display scale to maximize the waveform on the screen
And allow the user to change the ECG source/lead and/or AP source if desired.

27. Triggering

28. Definition
The computer in the IAB console needs a stimulus to cycle the pneumatic system which inflates and deflates the balloon.
The trigger signal tells the computer that another cardiac cycle has begun.

29. Options
In most cases it is preferable to use the R wave of the ECG as the trigger signal.
However, the operator also has the option of using the arterial pressure waveform or pacing spikes as the trigger event.

30. Patient Signal Connections
Direct connections are always best
Slaving signals from a separate monitor source (bedside monitor, anesthesia monitor) have the potential to alter the characteristics of patient waveforms, particularly pacing spikes.

31. ECG Use 4 or 5 Lead cable “Slaved” Direct Monitor HP Merlon Marquette
Tram
The AutoCAT® 2 series can accept a 4 or 5 lead cable, which is automatically recognized when connected to the console.
SpaceLabs
Use 4 or 5
Lead cable

32. AP Fiber Optic AP connection if LightWAVE™ catheter is used “Slaved”
Monitor AP
“Slaved”
Direct
one of these
HP Merlon
Marquette
Tram
The arterial pressure waveform can be attached directly to the pump or slaved in from a bedside monitor.
SpaceLabs
Fiber Optic AP connection if LightWAVE™ catheter is used

33. Unidirectional QRS with minimal artifact
FOR GOOD, CONSISTENT TRIGGERING IT IS IMPORTANT TO PROVIDE THE PUMP WITH A GOOD ECG SIGNAL
Good Choices –
Unidirectional QRS with minimal artifact
Poor Choices –
Biphasic QRS, tall T or P waves, wandering baseline, artifact present
It is important that the console recognizes the R WAVE consistently as it is the identification of the cardiac cycle which the timing is based upon.

34. This lead will give you both triggering and timing problems
Note the erratic signal; the computer in the pump can only act on the information it is given. In this case, the wavy signal and artifact distorts the R WAVE making it difficult to ascertain what waveform is the true R WAVE, so proper triggering will be difficult. Timing settings are based on where the pump determines that the cardiac cycle has begun (the ‘trigger’ point).
For timing to remain consistent, the ‘trigger point’ must not move.

35. ECG Pattern This is the preset trigger mode.
The computer analyzes the height, width ( msec), and slope of a positively or negatively deflected QRS complex.
Rejection of pacer spikes is automatic.
AutoPilot™’s choice when the QRS complex is normal and the HR < 130
Pattern is the most discriminating trigger due to it’s width criteria, minimizing the potential for mistriggering on P and T WAVEs. When AutoPilot™ is in use Pattern will be the selected trigger if the QRS complex is present, normal and the HR is less than 130 bpm.

36. ECG Peak
The computer analyzes the height and slope of a positively or negatively deflected QRS complex.
This may be the trigger mode of choice for wide complex or rapid rhythms.
Rejection of pacer spikes is automatic.
AutoPilot™’s choice when the QRS complex is wide, the HR > 130, or during arrhythmia when Arrhythmia Timing is OFF.
Peak is the trigger of choice for wide complex rhythms as it only requires the R WAVE to have slope. Also good for very rapid rhythms with heart rates > 140 as
Trigger is identified sooner than pattern, so can track faster rhythms
Heart rates at 140 can cause R WAVE to become aberrantly conducted due to repolarization state of AV node and R WAVE can widen out
When AutoPilot™ is in use Peak will be the selected trigger if the QRS complex is present, wide and/or the HR is greater than 130bpm. It will also be the trigger selected when an irregular rhythm is detected but ARRHYTHMIA TIMING is OFF.

37. AFIB
The computer analyzes the QRS complex in the same manner as Peak mode an initiates “Real-Time” timing.
Deflation is automatic when the next trigger event is identified, allowing for more consistent deflation timing when R to R intervals are irregular. Rejection of pacer spikes is automatic.
AutoPilot™’s choice the rhythm is irregular and Arrhythmia Timing is ON.
A-FIB trigger maintains balloon inflation until the next R WAVE occurs. Real-time timing means the pump is not concerned with the previous cardiac cycle, but inflates the IAB where the user sets inflation and deflates the balloon when the next trigger event is recognized.
R WAVE recognition criteria same as Peak
The deflation control becomes inactive as the console will deflate the balloon
Trigger of choice for irregular R-R intervals
Automatic pacer spike rejection
When AutoPilot™ is in use AFIB will be the selected trigger if the QRS complex is present, the rhythm is irregular and ARRHYTHMIA TIMING is ON.

38. Timing with Irregular Rhythms
“Real-Time” Timing
Conventional timing is when the inflation and deflation points are set by the user. It assumes deflation should occur when it did in the previous cardiac cycle. It works best with a regular diastolic period (like NSR).
Real Time timing keeps the balloon inflated throughout all of diastole, whether regular or irregular. It doesn’t care how long or short the previous diastolic period was. Deflation of the balloon is automatic when the next trigger event is recognized. It is the trigger of choice for irregular rhythms.
Conventional Timing

39. Arterial Pressure HR
The computer uses the systolic upstroke of the arterial pressure waveform as the trigger signal.
This mode is an option when an ECG is unavailable or distorted.
AutoPilot™’s choice when there are no R-waves available.
Arterial Pressure
The computer analyzes systolic upstroke of the arterial pressure waveform.
This option available for clinical situations where the ECG is unavailable or distorted.
This trigger works best with regular rhythms.
Requires regular, artifact free pressure tracing.
Trigger of choice during CPR.
When AutoPilot™ is in use AP will be the selected trigger when there are no QRS complexes present, but there is an AP waveform.

40. V Pace
The computer uses the ventricular spike as the trigger signal. This mode can be used with ventricular or AV paced rhythms.
Must be 100% paced.
AutoPilot™’s uses this mode when there are no R-waves or AP waveforms present, however, there are V or AV pacer spikes.
The computer analyzes ventricular pacer spike.
This option is available in the absence of a suitable R-WAVE and requires 100% paced patient rhythm.
Can be used for ventricular or A-V sequentially (Dual Chamber) paced rhythms.
Skin leads are always the preferred cable for pacer spike triggering
When AutoPilot™ is in use V Pace will be the selected trigger if there are no QRS complexes present and no AP waveforms but there are pacer spikes from a V or AV pacemaker.

41. A Pace
The computer uses the atrial pacing spike as the trigger signal. This mode can be used with atrially paced rhythms only.
Must be 100% paced.
AutoPilot™’s choice when the ECG is intermittent and pacer spike to R wave is > 100ms.
The computer analyzes the atrial pacer spike.
This option available in the absence of a suitable R-WAVE and requires a 100% atrially paced patient rhythm.
Skin leads are always the preferred cable for pacer spike triggering.
When AutoPilot™ is in use A Pace will be the selected trigger if there are no AP waveforms and the ECG is intermittent but there are pacer spikes seen more than 100ms in front of an R-WAVE.

42. Internal
The balloon inflates and deflates at a preset rate regardless of the patient’s cardiac activity.
This mode is only to be used when there is no cardiac output and no ECG.
Preset rate is 80 bpm; can be varied between 40 to 120.
An electronically generated signal, set initially at 80 cycles with rate selection variable between 40 – 120.
Cannot be selected accidentally as confirmation of internal trigger selection is necessary.
Used in the OR, when there is no organized myocardial contraction.
Used during CPR to prevent emboli forming on IAB.
AutoPilot™ will NEVER select this trigger mode.

43. Cardiac Arrest What do you do with the IABP?
Research has shown that 100% more coronary artery perfusion and 60% more carotid perfusion occurs when arterial pressure trigger is selected during CPR in a 1:1 assist frequency.

44. Helium Delivery
Helium is the gas that is shuttled in and out of the IAB catheter to inflate and deflate the balloon, altering the pressure gradients and creating the hemodynamic changes.
Helium is used as it is the lightest weight inert gas and can be shuttled very quickly.

45. Pneumatic Systems 2 types of gas delivery systems:
Vacuum / compressor system
Bellows / stepper motor system
The AutoCAT® 2 series both utilize the bellows / stepper motor pneumatic system

46. Balloon Pressure Waveform1 2 3 4 5 6 7 8 9
Zero Baseline
Balloon Pressure Baseline
Rapid Inflation
Peak Inflation Artifact
Plateau Pressure
Rapid Deflation
Deflation Artifact
Return to Baseline
Duration of Balloon Cycle
This is a normal Balloon Pressure waveform (BPW), which reflects the movement of gas in and out of the IAB catheter.

47. Helium Fill Pressure Stepper motor / bellows system BPW transducer
Fill Pressure
Helium moves from the helium tank into the bellows inside the pump forming the baseline of the BPW
Baseline should be 2.5 mmHg above the zero baseline
transducer
helium
pump

48. Balloon Inflation Stepper motor / bellows system BPW transducer helium
Balloon Inflation
Helium rushes from the bellows over the transducer into the balloon forming the upstroke of the BPW.
Initially there is a peak inflation artifact, key term being ‘artifact’.
This is not a true pressure change inside the patient, but rather a phenomenon of the gas passing by the transducer.
As the balloon fully inflates the pressure plateaus; this is the pressure created inside the patient’s aorta.
transducer
helium
pump

49. Balloon Deflation Stepper motor / bellows system BPW transducer helium
Balloon Deflation
Helium moves out of the balloon across the transducer into the bellows forming the downstroke of the BPW.
Initially there is a peak deflation artifact; the width reflects how quickly the catheter is deflating (narrow is quicker).
As the balloon fully deflates, the BPW returns back to its 2.5 mm baseline ready for the next inflation cycle.
transducer
helium
pump

50. Heart Rate Variations Tachycardia Bradycardia 250 250
250
The width of BPW represents the length of time the IAB is inflated.
When the patient is bradycardic diastole is long and the BPW is wide.
When the patient is tachycardic diastole is short and the BPW is narrow.
Tachycardia
Bradycardia

51. BPW in Irregular Diastole (Afib)
250
Diastole is the part of the cardiac cycle which changes with heart rate and rhythm.
When the rhythm is irregular, the width of the BPW is irregular.
This can especially be appreciated when the rhythm is AFIB.

52. Pressure Variations Hypertension Hypotension 250 250
250
The height of the plateau pressure of the BPW represents the pressure exerted by the console to overcome aortic pressure and inflate the balloon.
When the patient is hypertensive, the plateau pressure will be high.
When the patient is hypotensive, the plateau pressure will be low.
Hypertension
Hypotension

53. Comparison of Augmented AP waveform and Plateau of Balloon Pressure waveform
Comparison of BPW to AP
The width of the BPW corresponds to heart rate
The height of the BPW corresponds to the aortic pressure
Since the volume of gas is fixed, the BPW can be calibrated (scaled) and has a relationship to the ensuing aortic pressure change.
The plateau of the BPW should be within 20 mmHg (plus or minus) of the PDP.

54. Intra-aortic Relationship of Inflated Balloon Catheter and Vascular Pressure
IAB fully inflated
aorta
transmembrane
pressure
250 50
150
Once the balloon has been in the aorta for a few minutes, the membrane ‘warms up’ and becomes compliant so there is no pressure gradient across it.
When the IAB is approximately 90% occlusive of the aorta, the plateau pressure of the BPW should be within 20 mmHg of the PDP.
If the plateau pressure is more than 20 mmHg lower than the PDP, the IAB is less occlusive than optimal.
If the plateau pressure is more than 20 mmHg higher than the PDP, the IAB is more occlusive than optimal.
Note that the endpoint of the BPW plateau should be equal or up to 20 mmHg higher than the Augmented Pressure.

55. Troubleshooting Gas Surveillance Alarms
The gas surveillance alarm system is tied into the BPW.
The pressure is measured in the pneumatic system before the balloon inflates and before it deflates.
Alteration of these pressures can activate the gas alarm system.
If an alarm is activated (high pressure, high baseline, helium loss, etc), the pump goes to the ‘OFF’ position which deflates the IAB and vents the helium to the atmosphere.
An audible alarm is activated along with a troubleshooting message, help screen, and automatic printout of the AP and BPW.

56. Purge Failure
Pump did not fill adequately with helium to establish the balloon pressure waveform baseline
250
Purge Failure
The pump needs 3 things to purge (exchange air for helium) the balloon:
1. a valid trigger, so the console knows when diastole is (pump only purges in diastole)
2. the balloon connected, so the console knows what size to set the bellows
3. helium is connected, so the console can pressurize the system to it’s 2.5 mmHg baseline
Check these and reinitiate pumping
Verify:
Helium tank not empty
Catheter connections intact
Trigger present

57. High Baseline Check for: Partially wrapped balloon Kinked catheter 250
Check for:
Partially wrapped balloon
Kinked catheter
High Baseline
Occurs when the BPW baseline is more than 25mmHg above zero baseline
Can be caused by:
Kinked catheter
Partially wrapped balloon
Overfill of the helium system
Full cold trap
Check these conditions and reinitiate pumping

58. Helium Loss Check for: Leak in tubing and connections
250
Check for:
Leak in tubing and connections
Blood in catheter tubing
Kinked catheter
Ectopic beats
Possible Helium Loss
Note baseline has fallen below the zero baseline.
Gas has entered the balloon but did not return to the console, causing the BPW baseline to fall.
Check for presence of blood in gas tubing; if present, stop pumping and notify MD as balloon membrane abrasion may have occurred.
Check all gas line tubings and connections to the pump are tight and intact.
Check for kinking of the catheter, esp at insertion site and if IAB was inserted through a sheath; reposition affected leg.
When using ECG trigger, ectopics can cause the balloon to deflate and may cause an alarm depending on where in the inflation cycle it occurs.

59. Classic BPW appearance of a Kinked Catheter
If the catheter kinks after it has already been inflated, all the gas cannot return to the console from that inflation and then cannot leave the pneumatic system for the next cycle.

60. Internal Leak Test Turn alarms OFF Select INTERNAL trigger
pass
fail
Observe BPW baseline
for minutes
To test the pneumatic system of the console, disconnect the catheter and place a finger tightly over the center hole where the balloon is connected.
Verify that the gas alarms are ‘OFF’; select internal trigger if not on patient, then pump ‘ON’.
Observe the baseline of the BPW; if it remains stable, the pneumatics are competent.
BALLOON
Turn alarms OFF
Select INTERNAL trigger

61. IAB too Large for Aortic Environment
BPW
Balloon too tight in aorta so all the gas cannot fully inflate the IAB.
Can reduce the IAB volume until the plateau pressure returns; recommend not to remove any more than 1/3 of the IAB’s intended capacity as an increase in folds can occur in the under-inflated IAB potentially allowing a place for blood to aggregate.
transducer
helium
pump

62. Hands on review of the AutoCAT® 2 WAVETM