Patients with cardiological urgencies in special situations require mechanical devices and procedures to improve their outcome. Intra-aortic balloon pump counterpulsation is a device that inflates and deflates during the cardiac cycle, offering various hemodynamic benefits for the patient. It may be of benefit for patients with acute myocardial infarction complicated by cardiogenic shock, especially if there is papillary muscle or interventricular septum rupture. It can also be used in patients undergoing high-risk percutaneous coronary interventions. Emergency pericardiocentesis is a thoracic puncture to drain fluid, air, pus, or blood that acutely accumulates in the pericardial space. It is indicated in cardiac tamponade (triad of hypotension, muffled heart sounds, and tachycardia) and severe pericardial effusion. When available, the procedure should always be echocardiographic-guided. The transthoracic approach is the preferred method, but the traditional xiphoid puncture is mandatory if the patient is under cardiopulmonary resuscitation. Temporary pacemakers are indicated for atrioventricular block and other severe bradyarrhythmias that cause impending or hemodynamic instability. Additionally, it is also indicated when permanent pacemakers are to be revised for infection or malfunction. Finally, electrical cardioversion is the delivery of a synchronized shock to the heart to stop arrhythmias. Electrical cardioversion is used in atrial or ventricular tachycardia in the setting of impending or clinical instability. This chapter focuses on analyzing technical aspects and main indications of intra-aortic balloon pump, pericardiocentesis, temporary pacemakers, and electrical cardioversion.
