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Pump stopped: protecting the balloon

Procedure AC3 · pump-off-manual-inflation

Overview

What the clinician does when the intra-aortic balloon pump (IABP) stops, whether by PUMP OFF or by an alarm shutdown: note the time, restart as soon as possible, respond to the PUMP OFF LONGER THAN 3 MIN alarm, and if pumping cannot be restored within 15 to 30 minutes, cycle the dormant balloon by hand with a 50 or 60 cc syringe. A stopped balloon gives no support and blood trapped in its folds can form thrombus.

When to perform

Any time pumping stops after therapy has begun: a pump shutdown by a high-priority alarm, a system failure, or a deliberate PUMP OFF.

Equipment

  • 50 or 60 cc syringe
  • a back-up IABP available

Steps

  1. Recognize the stopped pump: the hard key and PUMP STATUS show OFF (red), the balloon has deflated, and a pump-off timer appears above the numeric display area, below the helium and battery icons.1

    A deflated balloon provides no cardiac assist, and the timer tells the clinician how long the patient has been without it.

  2. Note the time and call knowledgeable maintenance personnel.2

    Pump shutdown requires immediate action, and the time stopped drives the decisions that follow.

  3. Silence the alarm, read the alarm message and its Actions to Take, troubleshoot the cause, and press PUMP ON to restart as soon as possible.3

    Restarting as soon as possible prevents thrombus formation on the surface of the IAB.

  4. If the pump has been off for more than 3 minutes, expect the yellow PUMP OFF LONGER THAN 3 MIN alarm: press PUMP ON to resume, or ALARM SILENCE or DISMISS to remain in PUMP OFF. Pressing and holding PUMP OFF for 5 seconds disables this alarm, after which PUMP OFF ALARM TURNED OFF is displayed and the timer keeps counting.4

    Prolonged lack of pumping increases the risk of clot formation on the IAB surface, which is why the pump nags at 3 minutes; disabling the alarm is for direct supervision only.

  5. If pumping cannot be restored within 15 to 30 minutes, connect a 50 or 60 cc syringe to the balloon connector and manually inflate and deflate the balloon several times per hour.5

    Moving the balloon membrane disturbs the blood pooled in its folds before thrombus can organize.

  6. Consider removal of the IAB if pumping will not be restored, and bring in the back-up IABP.6

    A dormant balloon is a thrombus source with no benefit, so the options are to resume pumping on another console or to remove it.

Cautions

  • PUMP OFF means the patient is not receiving IABP support; use it only under direct clinical supervision and restart as soon as possible to prevent thrombus formation on the surface of the IAB.7
  • A pump shutdown deflates the balloon automatically; a deflated balloon gives no cardiac assist and thrombus can form in its folds.8
  • Have a backup IABP and extra helium ready.9
  • The PUMP OFF ALARM TURNED OFF state should be used with extreme caution and only under direct supervision; monitor the PUMP OFF timer.4

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 61.
  2. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 18.
  3. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 180.
  4. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 196.
  5. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 19.
  6. 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.
  7. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 60.
  8. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 162.
  9. Teleflex Inc. Arrow AC3 Safety Information: indications, contraindications, warnings, cautions, adverse events. Teleflex Interventional website. Updated April 20, 2023. Accessed October 23, 2026. Warning 22.
  10. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. pp 60-61.
  11. Arrow International Inc. AC3™ Series IABP System Service Manual. Part No. IAM-9011, Rev 00. Reading, PA: Arrow International Inc (Teleflex); 2015. p 112.