Troubleshooting

On any alarm, first silence it with the Corner switch or the Dismiss key in the Alarm Banner, then press i in the Alarm header to display Actions to Take.¹

On the AC3, red alarms are high priority, yellow alarms are medium priority, and blue alarms are low priority or information-only.^3,4

A high-priority (red) alarm stops pumping, automatically records an alarm strip, and freezes the display; medium- and low-priority alarms do none of these.⁴

Pump stopped: protecting the balloon Read AL-007Read AL-001Read AL-002

At initial start-up the HIGH PRESSURE alarm allows the IAB to unwrap for up to 300 beats (about 2 minutes 30 seconds); if the BPW plateau is above 250 mmHg but decreasing, the IABP lets the condition continue until the plateau falls below 250 mmHg.⁵

HIGH PRESSURE issues when the BPW is above 250 mmHg during inflation for 5 consecutive beats or 10 of the last 20 beats, most often from a kink in the IAB or driveline, an IAB not unwrapped or not fully exited from the sheath, or mispositioning.^5,6

Connect the IAB and start counterpulsation Read AL-017Read AL-016

HIGH BASELINE issues when the BPW exceeds 25 mmHg during deflation; if the IAB is suspected to be partially inflated, disconnect the IAB volume connector from the IABP and aspirate the IAB with a 60 cc slip tip syringe.^6,7

Confirm balloon position and function from the console Read AL-018

The first action for any HE loss alarm (He Loss 2, He Loss 3, Large Helium Leak) is to check for blood in the driveline tubing; if blood is present, DO NOT RESUME PUMPING, contact the physician and prepare for IAB removal.^8,9

Possible HE Loss 2 issues when the IABP attempts to refill the pneumatic system 3 times within 2 minutes and is the alarm most commonly associated with abrasion leaks, even before blood is seen in the tubing.¹⁰

He Loss 2 indicates a small leak (commonly abrasion); He Loss 3 indicates a moderate leak or impaired helium movement (kink, high HR, timing) and is tested by going to 1:2; LARGE HE LEAK is almost always a helium-pathway disconnection such as the IAB volume connector.^10,11,12

Helium leak test Read TS-010Read AL-012Read TS-011

The first action for any HE loss alarm (He Loss 2, He Loss 3, Large Helium Leak) is to check for blood in the driveline tubing; if blood is present, DO NOT RESUME PUMPING, contact the physician and prepare for IAB removal.^8,9

Possible HE Loss 3 issues when the BPW baseline falls below -10 mmHg for 3 consecutive beats and may indicate a moderate leak or a problem with helium movement between IAB and IABP.¹¹

To tell whether Possible HE Loss 3 is from a kink, high heart rate, or timing rather than a leak, place the pump in 1:2 and see if the alarm persists; if it clears, adjust timing or slightly reduce volume, or correct any kink.¹¹

Helium leak test Read TS-010Read AL-014Read AL-015

LARGE HE LEAK issues when the BPW plateau is below 5 mmHg during inflation or the plateau drops more than 50% beat to beat; it is almost always a disconnection in the helium pathway and is a high-risk condition requiring immediate assessment of the patient and driveline for blood.¹²

If blood is present in the tubing on any helium-loss alarm (Possible HE Loss 2, Possible HE Loss 3, or LARGE HE LEAK), DISCONNECT the IAB connector from the IABP, clamp the tubing to prevent bleeding, DO NOT RESUME PUMPING, and replace the IAB as necessary.^10,11,12

Helium leak test Read AL-019Read AL-013

PURGE FAILURE has three primary reasons: the IAB is not connected or the pneumatic system is open to air, no helium is available (tank low, empty, or OFF), or no trigger is found; very rarely a mechanical failure prevents filling.^13,14,15

The purge cycle is synchronized to the cardiac cycle so a trigger must be present; the Heart icon by the HR flashes each time a trigger is detected, and if AutoPilot™ finds no acceptable trigger you select Operator mode, press TRIGGER, and choose an appropriate trigger.¹⁴

Start-up and Getting Started checklist Read AL-020Read AL-021

Unable to Refill issues when the BPW baseline is below 2.5 mmHg after 8 fill attempts, usually from an empty or closed helium tank, incorrect timing, or a leak.¹⁶

Change the helium tank Read AL-011

ECG TRIGGER LOSS, AP TRIGGER LOSS, and TRIGGER LOSS issue after no trigger is detected for more than 8 seconds with alarms ON, or more than 30 seconds with alarms OFF.^17,18,19

ECG TRIGGER LOSS and AP TRIGGER LOSS are Operator-mode-only alarms, whereas TRIGGER LOSS is an AutoPilot™-mode-only alarm meaning AutoPilot™ could not find a valid trigger mode.^17,18,19

Read AL-023Read AL-024

ECG LEAD FAULT names the affected lead (RL or All, RA, LA, LL, V) in the alarm heading; in AutoPilot™ an alternative lead may already have been selected but the fault must still be corrected, and in Operator mode the operator must correct it, including using a 5-lead ECG cable.^20,21

Electrode air gaps to the skin cause a missing ECG or a wandering ECG baseline; apply gel or replace the medically-certified electrode pads.^22,23

Read AL-025Read TS-007

PUMP OFF LONGER THAN 3 MIN is a medium-priority (yellow) alarm; press PUMP ON to resume, press ALARM SILENCE or DISMISS to remain in PUMP OFF, or press and hold PUMP OFF for 5 seconds to disable the alarm, which then issues PUMP OFF ALARM TURNED OFF.^24,25

If balloon pumping is interrupted and cannot be continued within 15–30 minutes, connect a 50/60 cc syringe to the balloon connector and inflate and deflate the balloon manually to prevent thrombus forming in the folds of the dormant balloon.²⁶

Pump stopped: protecting the balloon Read AL-022Read ST-022

HELIUM TANK LOW OR EMPTY issues when the helium tank pressure falls below 100 psi, meaning the tank is very low, OFF, or empty; check the helium supply, open the tank, then change the tank.²⁷

The HELIUM TANK LOW OR EMPTY alarm issues when HE tank pressure has fallen below 100 psi; it is a Low Priority alarm, so the pump keeps running.^27,28,29

Change the helium tank Read AL-028Read HP-004

ESTIMATED BATTERY TIME REMAINING: LESS THAN 20 MINUTES (low priority) and ESTIMATED BATTERY TIME REMAINING: LESS THAN 10 MINUTES (medium priority) both mean the battery is almost depleted and the IABP should be connected to AC power as soon as possible.^19,30,31

On battery the AC3 Series runs with full operational capability for a minimum of 90 minutes with the standard battery, or a minimum of 180 minutes with the optional battery.^32,33

Annual battery load test Read AL-026Read HW-003

WARNING: BATTERY IS INOPERATIVE is most often caused by the circuit breaker in the helium compartment being OFF; do not transport the IABP until the condition is resolved, or exchange the IABP before transport.³⁴

If the pump operates on AC but not on battery, check that the circuit breaker in the helium compartment is in the ON position and check the battery discharge condition.³⁵

Annual battery load test Read AL-027Read TS-002

With AP FOS CAL KEY MISSING OR CORRUPT the FOS sensor cannot be zeroed, and although the waveform still appears, the AP hemodynamic readings may not be accurate and should not be used for hemodynamic assessment.³⁶

FOS zeroing requires connecting the CAL key and the FOS sensor slider, except that a FOS with an RFID tag (Yellow slider) does not need the CAL key; if both RFID and CAL key are present the AC3 Optimus™ uses the RFID.^37,38

Zero the FiberOptix™ sensor before insertion Read AL-029Read ST-017

AP FOS SENSOR OUT OF RANGE issues on FOS status codes PL, BL, TL, RE, or EO; if it persists, AP FOS values should not be used for therapeutic decisions, though WAVE™ timing may still be acceptable if inflation timing is correct.^39,40,41,42

Loss of the AP FOS signal (including SYSTEM ERROR 8 — FOS SYSTEM ERROR) does not require IAB removal or replacement; cycle power and select an alternate AP source, disconnecting the AP FOS connector from the IABP if needed.^40,43

Read AL-030Read AL-010

Internal trigger should not be used when the patient has intrinsic cardiac activity; if an ECG signal is detected while in Internal, the IABP issues the 'POSSIBLE ECG SIGNAL DETECTED' alarm and the operator should select a patient-based (ECG or AP) trigger, otherwise asynchronous pumping may result.^44,45

Read TT-022

Only Pneumatic (High Priority) alarms can be suspended with ALARMS OFF, for a duration of 10 to 60 minutes in 5-minute increments.^1,46

While alarms are suspended, the IABP continues to monitor and display alarm messages but will not sound audio, stop pumping, or print a recorder strip.^1,17,18,19

Suspend and restore alarms Read AL-005Read AL-006

A pump shutdown automatically deflates the balloon, and thrombus can form in the folds of a deflated balloon.²⁵

If balloon pumping is interrupted and cannot be continued within 15–30 minutes, connect a 50/60 cc syringe to the balloon connector and inflate and deflate the balloon manually to prevent thrombus forming in the folds of the dormant balloon.²⁶

Pump stopped: protecting the balloon Read TS-001Read ST-022

A completely discharged battery with AC not connected produces a Piezo (high pitched) alarm tone and the pump may not power ON until AC is connected.⁴⁷

If the pump operates on AC but not on battery, check that the circuit breaker in the helium compartment is in the ON position and check the battery discharge condition.³⁵

Read HW-006Read TS-002

Reduced augmentation appears as a low BPW plateau pressure, and late inflation is one cause because aortic blood has already run off to the periphery, leaving less volume to displace.^6,48

The BPW plateau and AUG should be within +/- 25 mmHg of each other; use the cursor to verify BPW plateau pressure.^2,5,49

Best augmentation occurs when stroke volume equals balloon volume (a 40 cc balloon works best at 40 cc stroke volume); augmentation decreases if stroke volume goes above or below balloon volume.⁴⁸

Protective Pumping™ balloon sizing check Read TS-023Read TS-019Read TS-024

A squared balloon pressure waveform has three causes: a kink in the catheter, sheath or balloon membrane; a balloon that has not unwrapped; or an occlusive IAB.^5,7,49

For a balloon that has not unwrapped, notify the physician, aspirate approximately 50 cc of air, then inject approximately 50 cc of air into the balloon connector and aspirate or disconnect the syringe from the IAB connector.⁴⁹

Confirm balloon position and function from the console Read TS-020Read TS-021

If an IAB is suspected occlusive, decrease balloon inflation volume with the Volume key but do not reduce it below 2/3 (66%) of the balloon's capacity, and pump the balloon at maximum capacity for five minutes every hour to prevent thrombus.⁴⁹

Because patient height correlates poorly with aortic length, the AC3 Optimus™ offers a Protective Pumping™ check that compares the balloon pressure plateau with the augmented pressure, targeting 90 to 95 percent occlusion with the plateau within 25 mmHg of the augmented pressure.^50,51

Protective Pumping™ balloon sizing check Read TS-022Read FN-017

The balloon pressure waveform shows helium moving between console and balloon and has nine named points, zero baseline, balloon pressure baseline, rapid inflation, peak inflation artifact, plateau pressure, rapid deflation, deflation artifact, return to baseline and duration of inflation, with the plateau expected within 25 mmHg of AUG and the width approximating the time the balloon is inflated.^2,49,52

Each abnormal balloon pressure waveform has a short manufacturer check-list: purge failure points to loss of trigger, a disconnected balloon, leaks or low helium; a low plateau to low volume, a small or low balloon or low vascular resistance; wide artifacts to a balloon partly in its sheath, a tight suture, a kink or tortuous vessels; a high baseline to a kinked, partly wrapped, sheathed, low or oversized balloon or overfill; a baseline below zero to blood in the tubing, a leak, a kink or ectopy; and a squared or rounded high plateau to a kink or a balloon too large or malpositioned.^6,53

Confirm balloon position and function from the console Read TS-027Read TS-028

Timing is judged on six arterial-pressure landmarks, DIA, SYS and DN on an unassisted beat and AUG, ADIA and ASYS on an assisted beat and the systole after it, against three rules from the manufacturer: inflate just before DN so that AUG exceeds SYS, ADIA is lower than DIA, and ASYS is lower than SYS.^2,54,55

On an AC3 Optimus™ with a FiberOptix™ sensor, assess timing from the IABP AP FiberOptix™ waveform, because fluid-filled transducer AP waveforms have significant delays that make timing appear earlier than on the FiberOptix™ waveform.^2,56

Assess timing on the arterial waveform Read TT-031Read TT-027

R-Wave deflation may not be appropriate for all patients: with ALWAYS R-Wave or AFIB trigger selected, late deflation can result, so monitor hemodynamics closely and be prepared to select NEVER R-Wave or an alternate trigger if hemodynamics worsen.^57,58,59

AFIB trigger inflates based on PEAK mode and deflates when the slope of the R-Wave begins to rise; AutoPilot™ selects it when an arrhythmia is detected and Deflation Timing Management indicates enough time to remove at least 70% of the IAB volume before the next systole, or when ALWAYS R-Wave is selected.^57,59,60,61

Assess timing on the arterial waveform Read TT-012Read TT-016

When no ECG waveform is displayed, the first operator check is the ECG signal source, changed by pressing the Select key.²²

Electrode air gaps to the skin cause a missing ECG or a wandering ECG baseline; apply gel or replace the medically-certified electrode pads.^22,23

Read TS-005Read TS-007

For 50/60 Hz AC interference in the ECG, verify grounding, try another AC outlet, and move the IABP away from EMI-emitting equipment; each 10x of distance decreases EMI interference by 1/100.²³

Electrode air gaps to the skin cause a missing ECG or a wandering ECG baseline; apply gel or replace the medically-certified electrode pads.^22,23

Read TS-006Read TS-007

For R-wave triggering, select the ECG lead with the most unidirectional R-wave, positive or negative, and the smallest P and T waves, because leads with inconsistent R-waves, pacer tails from a high-output temporary pacer, noise, a wandering baseline or a biphasic QRS cause double triggering, missed triggers or wandering timing.^6,62

Read TT-032

A FiberOptix™ mean pressure that prints the same value beat after beat (for example 15, 15, 15, 15) is not tracking a live aortic pressure; check the patient, check that the numbers match a pulsatile AP waveform, read the source and FOS MAP CAL label, read the FOS status code, and correct with FOS MAP CAL against a zeroed reference line or switch to another AP source.^{40,63,64,65,66,67}

Pressing More then Status shows a two-letter FiberOptix™ status code: OK means the sensor is working; LL and SL point to the connection, CK and RE to the calibration data, TL to the electronics still warming up, BL to altitude above 10,000 feet, and PL or EO to pressure on the sensor or an improper zero or calibration.^40,65

FOS MAP calibration against a reference line Read AP-023Read AP-022

Pressing More then Status shows a two-letter FiberOptix™ status code: OK means the sensor is working; LL and SL point to the connection, CK and RE to the calibration data, TL to the electronics still warming up, BL to altitude above 10,000 feet, and PL or EO to pressure on the sensor or an improper zero or calibration.^40,65

Read AP-022

A successful FOS zero is verified by a correct date/time of zero, a Zero Icon with no RED line through it, and a numerical value of 0 mmHg in the hemodynamics area.^68,69

AP FOS CAL calibrates the mean pressure (MAP) of the AP FOS signal to a reference AP MAP when the sensor was not zeroed or was zeroed improperly, and the FOS MAP is adjusted up or down in 5 mmHg increments.^63,70,71

FOS MAP calibration against a reference line Read AP-007Read AP-010

If the FOS becomes non-operational, AutoPilot™ selects an alternate AP source; in Operator mode the operator must select one, and if AutoPilot™ does not switch, disconnect the AP FOS connector and connect another AP source.^40,72

Loss of the AP FOS signal (including SYSTEM ERROR 8 — FOS SYSTEM ERROR) does not require IAB removal or replacement; cycle power and select an alternate AP source, disconnecting the AP FOS connector from the IABP if needed.^40,43

Read TS-009Read AL-010

The AP FiberOptix™ Sensor is the AC3 Optimus™ preferred signal and is selected automatically when available; to display or use another AP source the FiberOptix™ must be disconnected from the IABP.⁷³

Read ST-021

When no AP waveform appears from a fluid-filled transducer or AP MON, the possible cause is an occluded catheter central lumen or needle; check the AP source with the Select key and the AP cables.⁷²

Read TS-008

Switching AP SOURCE during an AP alarm can reset the alarm even if a serious condition such as tubing disconnection has occurred, so the operator must verify that the transducer or monitor lines are intact and that bleeding has not occurred.^74,75

If the AP alarm is used primarily to monitor for AP disconnect, MAP must be the parameter because it is available pumping and not pumping, whereas AUG is only available while pumping and may not alert to disconnection under all conditions.⁷⁴

Read AP-021Read AP-020

If the HE tank loses pressure faster than expected, check the O-ring on the HE regulator yoke, check the HE tank adapter, and perform a leak test.⁷⁶

Helium leak test Read TS-004

If the pump operates on AC but not on battery, check that the circuit breaker in the helium compartment is in the ON position and check the battery discharge condition.³⁵

The DC circuit breaker at the lower right of the helium storage compartment must be ON for Battery mode operation and for the battery to charge; it is shipped OFF.^30,77,78

Annual battery load test Read TS-002Read HP-016

Touchscreen calibration is reached via More, then the System tab, then Touchscreen calibration; if that screen will not display, press and HOLD the Up AND Down cursor keys for more than 5 seconds to force it.⁷⁹

Read TS-003

Arrow® intra-aortic balloons come in 30, 40 and 50 cc sizes on 7 to 8 French catheters, with manufacturer height guidelines of 30 cc for 4 feet 10 inches to 5 feet 4 inches, 40 cc for 5 feet 4 inches to 6 feet, and 50 cc for taller than 5 feet 8 inches.⁸⁰

Because patient height correlates poorly with aortic length, the AC3 Optimus™ offers a Protective Pumping™ check that compares the balloon pressure plateau with the augmented pressure, targeting 90 to 95 percent occlusion with the plateau within 25 mmHg of the augmented pressure.^50,51

Protective Pumping™ balloon sizing check Read FN-016Read FN-017