Key messages

• The use of the intra-aortic balloon counterpulsation pump (IABP) can improve the function of the failing heart and may be lifesaving.

• IABP carries a significant mortality and morbidity.

• IABP is precisely timed with the onset of diastole and therefore augments both the diastolic pressure and the coronary perfusion pressure.

• The deflation of the balloon is precisely timed just prior to the onset of systole, thus creating a relative 'vacuum' in the aorta and reducing the afterload.

• Hemodynamically significant aortic regurgitation is a contraindication.

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