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.
