The Rise of Mechanical Circulatory Support Devices What Critical Care Physicians Need to Know Felipe Teran-Merino M.D. Part 2 of 2 (read part 1) II. Main MCS devices used for emergency and short-term support Intra-Aortic Balloon Pump The oldest and simplest mechanical device is the intra-aortic balloon pump (IABP). Introduced in 1968, the IABP is still used as a ventricular assist device in many centers across the US. It consists of a catheter with a balloon on its end, which is inserted percutaneously into the femoral artery and advanced retrograde up to the aorta just distal to the left subclavian artery. The IABP is inflated during diastole, improving coronary perfusion by increasing DBP. During systole the balloon is actively deflated unloading the LV by decreasing the afterload. The IABP can improve CO by 25-30%. The main limitation of the IAPB is that it relies on the native LV function. While used widely over the past two decades, on the basis of registry data and retrospective meta-analyses and randomized trials that failed to demonstrate a mortality benefit, the AHA in its 2013 Guidelines for the management of STEMI, downgraded the recommendation from Class I to Class IIa1. [gallery size="medium" columns="2" link="none" ids="15071,15068"]