Intra-aortic balloon counterpulsation is the most widely used therapy for support of a compromised left ventricle. The principles of counterpulsation were developed in the 1950s, and intra-aortic balloon pumps have been used for more than 40 years. Despite this long-standing clinical use, many of the timing practices have continued almost unchanged from their inception. One of the most important aspects of the pumps is timing, or synchronizing the action of the device with the cardiac cycle. The principles of timing are based on the physiological objectives of counterpulsation; however, research into alternative timing methods has led to conflicting and often confusing information on the appropriate timing method for a specific clinical situation or patient. Although a body of knowledge is available, much of the research is dated and covers only specific timing methods or populations of patients. Notice to CE enrollees:A closed-book, multiple-choice examination following this article tests your under standing of the following objectives:1. Describe the pathophysiological effects and goals of intra-aortic balloon pump counterpulsation. 2. Identify factors that affect intra-aortic balloon counterpulsation efficacy and appropriate hemodynamic assessment parameters for evaluating efficacy of counterpulsation therapy. 3. Discuss timing methods, potential timing errors, and considerations for timing of intraaortic balloon pump counterpulsation in specific clinical situations.

Pulmonary artery pressures and arterial pressures are important hemodynamic measurements utilized in clinical management decision making for critically ill patients. Studies have demonstrated a concerning rate of measurement error, often due to technical errors. Zeroing, leveling, and dynamic response testing are essential components of assuring the quality of measurements. This article describes a multilevel approach to assuring the accuracy of measurements. It includes the physics underlying each of these principles, criteria for judging the efficacy of the dynamic response, and clinically applicable methods for measuring the natural frequency and damping coefficient of pressure monitoring systems.

This paper reviews arterial pressure waveforms and contrasts the differences in waveforms imposed by intra-aortic balloon counterpulsation. It explores questions regarding blood pressure interpretation and offers guidelines for practice.

This article recognizes challenges facing the traditional clinical nurse specialist (CNS) role and supports the merger of the nurse practitioner (NP) and the CNS into a hybrid advanced practice registered nurse (APRN). A historical review of each role is presented, with justification for role merger. The focus of the article is to present a personal account of this author's successful reengineering of a traditional cardiovascular CNS role to conform to a new state and institutional APRN model and ultimately to better serve a population of post-myocardial infarction patients.