Ultrasound-guided insertion of intra-aortic balloon counterpulsation in intensive care: description of the technique

Figures

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  Fig. 1. a Subxiphoid left paramedian longitudinal section with a low-frequency convex transducer, using the left hepatic lobe (LHL) as a window, showing a pulsatile and anechogenic tubular image, supported on the vertebral bodies, corresponding to the aorta. From the ventral face, the celiac trunk emerges first, and then the superior mesenteric artery runs parallel to the aorta shortly after emerging, following the aorta to the aortic bifurcation. b The aorta should be followed distally until the aortic bifurcation

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  Fig. 2. a Short-axis visualization of the femoral artery with a high-frequency linear transducer 6.9 mm in diameter. b Puncture under direct visualization. c Long-axis visualization of the femoral artery as the needle enters the femoral artery during puncture

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  Fig. 3. a Passage of the metal guide through the femoral arterial puncture. b Visualization of the passage of the intravascular guide at the femoral artery with a high-frequency linear transducer. c Verification of the metal guide (yellow arrow) in the abdominal aorta with a low-frequency convex transducer

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  Fig. 4. a Distance from the second intercostal space to the right common femoral artery. b Measurement of the distance for inserting the IAoBC. c Passage of the IAoBC

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  Fig. 5. a Supraclavicular approach with a phased array transducer, left supraclavicular window, ascending (Asc) and descending (Des) aorta and the left subclavian artery (SV). b IAoBC connected to the console and with adequate counterpulsation

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  Fig. 6. a Right, transhepatic, longitudinal window (between the seventh and eighth intercostal space along the axillary midline) with a low-frequency transducer showing the inferior vena cava and the aorta with the functioning IAoBC. b Left paramedian longitudinal window to evaluate the exit of the abdominal vessels; in this case, we observe the IAoBC obstructing the superior mesenteric artery exit; thus, the IAoBC was advanced another 5 cm

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  Fig. 7. Proposed technique for ultrasound-guided intra-aortic balloon counterpulsation insertion