The contraindications to IABP placement include:

• Significant aortic insufficiency (IABP-induced increased diastolic pressure will worsen the severity of aortic valvular incompetence and increase LV diastolic pressure)

• Major aortic pathology (aneurysm, dissection, severe atherosclerotic plaque)

• Sepsis, with the risk of colonization of the IABP catheter

• Uncontrolled coagulopathy

• Cancer with metastasis

The potential complications include:

• Vascular injury at the placement site is the most common complication of IABP placement. This is especially true in patients with severe peripheral vascular disease (reported as 8%-18%, with major limb ischemia reported at 1%). Bleeding at the insertion site is another major complication.

• Thrombocytopenia has been reported in 57.9% of patients receiving IABP but has not been associated with major bleeding events or mortality.

• A rare complication is the rupture of IABP, causing a gas embolism.

References

• Heuts S, Lorusso R, di Mauro M, et al. GIROC-investigators. Sheathless versus sheathed intra-aortic balloon pump implantation in patients undergoing cardiac surgery. Am J Cardiol. 2023;189:86-92.
• Parissis H, Soo A, Al-Alao B. Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump. J Cardiothorac Surg. 2011;6:147.
• Sheng Z, Zhao H, Yan H, et al. Intra-aortic balloon pumping and thrombocytopenia in patients with acute coronary syndrome: incidence, risk factors, and prognosis. Herz. 2018;43:555-564.