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Connect the IAB and start counterpulsation

Procedure AC3 · iab-connect-and-start

Overview

After the intra-aortic balloon (IAB) has been inserted and positioned per its Instructions for Use, this is how the clinician connects the balloon to the AC3 Optimus™, confirms the console knows the balloon's volume, starts pumping, and reads the first minutes of balloon pressure correctly. Insertion technique itself (access, guidewire, sheath, advancing to the correct aortic position) is governed by the IAB catheter IFU, which is not part of this course; the console steps below assume it has been followed.

When to perform

Immediately after IAB insertion, with ECG and arterial pressure (AP) already connected and (if FiberOptix™) the sensor zeroed before insertion.

Equipment

  • IAB with its Arrow®- or Kontron®-marked volume connector
  • extender tubing
  • FiberOptix™ slider and CAL key or RFID (if FOS IAB)

Controls involved

Balloon connector port (front of pneumatic module)1
Accepts the color/size-coded IAB volume connector. The console reads the connector code to preset full volume; with no connector it shows '--- cc'.
Volume key (touchscreen)2
Shows the preset volume from the connector; lets the clinician change it in 0.5 cc steps up to the connector's capacity (APPLY momentarily suspends support).
Start Pump hard key / Pump ON (touchscreen)3
Starts the purge cycle then counterpulsation. Blue when the Getting Started checklist is all green.
Pump OFF (touchscreen)4
Stops pumping and starts the pump-off timer; the patient has no support while it shows.

Steps

  1. Confirm the IAB has been inserted and positioned according to its Instructions for Use, and that the sheath has been withdrawn so the whole membrane is outside it (or the balloon advanced fully out of a sheath longer than 15 cm).5

    A balloon still partly in the sheath cannot open; the console will report it as HIGH PRESSURE or HIGH BASELINE rather than as a positioning problem.

  2. Connect the extender tubing between the IAB catheter and the console's balloon connector port, and check that the connector carries an ARROW or KONTRON 30/35/40/50 cc marking.6

    The console has no other way to know the balloon's capacity; an unmarked or wrongly coded connector can set the wrong volume.

  3. Read the IAB volume shown on the Volume key and confirm it matches the balloon that was inserted; correct it with the Volume key if the physician ordered less than full volume.2

    Volume is preset to full from the connector code; a mismatch means the wrong balloon or wrong connector.

  4. Confirm the Getting Started checklist shows green for helium, trigger and IAB, and that the Start Pump key has turned blue.7

    The console blocks starting until gas, a trigger and a recognized balloon are all present.

  5. Press Start Pump (hard key) or Pump ON (touchscreen) and wait for the purge cycle to finish; pumping begins when the balloon pressure waveform appears.8

    The first start after power-up runs a special purge that replaces ambient air in the line with helium before any gas reaches the balloon.

  6. Watch the balloon pressure waveform for the first 2–3 minutes: a high plateau that is falling is the balloon unwrapping and is tolerated for up to 300 beats before HIGH PRESSURE alarms normally.5

    A freshly inserted balloon is still folded; the console deliberately suppresses the high-pressure alarm while the plateau is decreasing toward normal.

  7. If the plateau stays above the augmented pressure after the unwrap period, stop and look for a kink, a balloon not fully out of the sheath, or a balloon that is too high, too low or too large — do not simply reduce volume.9

    A squared, persistently high plateau means the balloon cannot expand; the cause is almost always mechanical or positional.

  8. Proceed to timing assessment and the balloon sizing check, and verify that alarms are ON.10

    Starting the pump is not the same as delivering good support; the next two procedures confirm it.

Cautions

  • Verify balloon volume before operating the pump; a connector coded for a larger volume than the balloon can have serious clinical consequences.11
  • If pumping cannot be restored within 15–30 minutes, inflate and deflate the balloon manually with a 50/60 cc syringe several times per hour.12
  • Changing IAB volume while pumping momentarily suspends support until APPLY is pressed.13

Related knowledge

References

  1. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 99.
  2. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 125.
  3. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 104.
  4. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Caution 14.
  5. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 191.
  6. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 79.
  7. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 101.
  8. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 132.
  9. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 224-225.
  10. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 106.
  11. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 34.
  12. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 26.
  13. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Caution 18.
  14. Arrow FiberOptix IAB shelf-stock box labels, REF IAB-05840-LWS-SC (40 cc) and IAB-05850-LWS-SC (50 cc), lots 2025 [photograph]. Course author's photograph; October 2026.