Timing of intraaortic balloon pump inflation and deflation

(A) The timing of balloon inflation is adjusted until it occurs late in diastole, uncovering the dicrotic notch. Subsequently, inflation timing is moved earlier in the cardiac cycle until the dicrotic notch on the central aortic tracing just disappears (beat #4). The augmented pressure will rise as inflation timing is moved earlier.
(B) Deflation knob is moved toward the right (later in the cardiac cycle) until the end diastolic dip is 10 to 15 mmHg below the patient's unassisted diastolic pressure. This will produce a maximal lowering of the patient's unassisted systolic pressure.
(C) The balloon console is triggering on an atrial pacing artifact. This is corrected by changing the console to a mode that will discriminate between a pacing spike and an R wave.