Intra-aortic balloon pump (IABP): a Cath Lab 101 guide
Reviewed by Rodnie Oro, cath lab charge nurse · Last reviewed: October 2026 · Education only, not medical advice
Intra-aortic balloon pump in one minute
What it is: a long, thin balloon placed in the aorta that inflates when the heart relaxes and deflates just before it pumps, to reduce the heart's workload and improve blood flow to the heart.
Who it is for: some people with cardiogenic shock, severe heart failure, mechanical complications of a heart attack, or during high-risk procedures.
Main risks: reduced blood flow to the leg, bleeding, damage to the artery, infection, and rarely balloon rupture or stroke.
Usually: inserted in the cath lab under local anaesthetic, and stays in for hours to days on intensive care.
On this page: What is an intra-aortic balloon pump? · Who is it for? · When is it done? · Step by step · Recovery · Risks · Kit list · First time in the lab? · FAQ
What is an intra-aortic balloon pump?
An IABP is a form of mechanical circulatory support.
- a catheter with a long balloon is passed from the femoral artery into the descending aorta, just below the arteries to the arms
- a console inflates it with helium in time with the ECG or pressure trace
- inflation when the heart relaxes pushes blood back towards the coronary arteries
- deflation just before the heart pumps lowers the pressure it pumps against
Current guidelines no longer advise routine IABP for shock after a heart attack, but it is still used in selected cases.
New to the acronyms? See the Cath Lab Abbreviations A–Z.
Who is it for?
It may be considered for people with:
- cardiogenic shock in selected cases
- mechanical complications of a heart attack, such as a ruptured valve or septum
- support during high-risk PCI or before surgery
- bridge to other treatments
The decision is made by your heart team, who will talk through the reasons, the alternatives and the risks with you.
When is it done?
It can be planned in advance or done urgently. Before it, you usually have:
- blood tests, including kidney function and blood count
- an ECG, and often an echo or other scan
- a review of your medicines, especially blood thinners and diabetes medicines, as per centre protocol
- a chance to ask questions and give consent
Step by step
1. Getting ready
You lie on the X-ray table. ECG, blood pressure and oxygen levels are monitored. The skin over the access site is cleaned and numbed with local anaesthetic; some people also have light sedation, as per centre protocol.
2. Access
A sheath is placed in the femoral artery in the groin, sizes per device and operator. The balloon is passed over a wire into the descending aorta.
3. Insertion
- A. Wire. A guidewire is passed up the aorta.
- B. Balloon in. The balloon catheter is advanced over the wire.
- C. Position. The tip sits just below the left subclavian artery on X-ray.
- D. Timing. The console is connected and timing adjusted.
4. Finishing
The catheter is secured and dressed. A chest X-ray is often used to check its position on the unit.
Recovery and aftercare
- Monitoring: usually in a coronary care unit or intensive care, with close checks of rhythm, blood pressure and the access site.
- Lying still: you may need to keep the leg straight while a groin device is in place.
- Removal: the device or line is removed when it is no longer needed, and pressure applied.
- Follow-up: depends on the underlying condition.
- Leg checks: regular checks of pulses and warmth in the leg.
Call 999 if you have chest pain, breathlessness, fainting, signs of a stroke, or heavy bleeding or swelling at the access site.
Risks and complications
Your team will explain the risks that apply to you. Possible problems include:
- reduced blood flow to the leg
- bleeding at the groin
- damage to the artery
- infection
- low platelets
- balloon rupture or stroke (rare)
Cath lab kit list (printable)
Barts example kit list
An example from one UK centre, written generically. Every lab has its own protocol, and sizes and doses vary.
- femoral sheath, size per device and operator
- IABP catheter, size per device and patient height
- IABP console with helium
- pressure transducer
- heparin, as per centre protocol
Procedural steps (Barts example)
- Femoral access
- Wire up the aorta; balloon advanced
- Tip below left subclavian on X-ray
- Console connected; timing set
- Secure; leg pulse check
First time in the cath lab?
đź’ˇ First-time tip
- Check helium. Ensure the tank is open.
- Leg pulses. Check before and after.
- Timing. Inflation at the dicrotic notch.
- Keep leg straight. Explain why to the patient.
FAQ
Will I feel it?
Some people feel a pulsing sensation.
How long does it stay in?
Hours to days.
Can I move?
The leg needs to stay fairly straight.
Related Cath Lab 101 guides
Sources
All checked on 10 October 2026. Each page's own date is shown where it gives one.
- Byrne RA, et al. 2023 ESC Guidelines for the management of acute coronary syndromes. Eur Heart J 2023;44(38):3720–3826. PubMed 37622654
- McDonagh TA, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J 2021;42(36):3599–3726. PubMed 34447992
- StatPearls (NCBI Bookshelf), search: intra-aortic balloon pump. ncbi.nlm.nih.gov/books
Disclaimer
Education only. This page is for general education for healthcare students, cath lab staff and curious readers. It isn't medical advice and doesn't replace advice from your own doctor, heart team or local unit protocols. Equipment and medicines are described generically. No product or manufacturer is recommended. If you think someone is having a heart emergency, call 999.
Disclosure: I work in the medical device industry. This page is independent education and isn't sponsored or reviewed by any company.
All diagrams on this page are original illustrations created for rodnieoro.com.
