Monitoring of the patient supported with a temporary mechanical circulatory support (tMCS) is crucial in achieving the best possible outcome. Monitoring is a continuous and labour-intensive process, as cardiogenic shock (CS) patients can rapidly deteriorate and may require new interventions within a short time period. Echocardiography and invasive haemodynamic monitoring form the cornerstone of successful tMCS support. During monitoring, it is particularly important to ensure that adequate end-organ perfusion is achieved and maintained. Here, we provide a comprehensive overview of best practices for monitoring the CS patient supported by a micro-axial flow pump, veno-arterial extracorporeal membrane oxygenation, and both devices simultaneously (ECMELLA approach). It is a complex process that encompasses device control, haemodynamic control and stabilization, monitoring of interventions, and assessment of end-organ function. The combined, continuous, and preferably protocol-based approach of echocardiography, evaluation of biomarkers, end-organ assessment, and haemodynamic parameters is crucial in assessing this critically ill CS patient population.

2nd Department of Internal Medicine Cardiovascular Medicine General Teaching Hospital and 1st Faculty of Medicine Charles University Prague Prague Czech Republic

Adult Intensive Care Royal Brompton and Harefield Guy's and St Thomas' NHS Foundation Trust Sydney St London SW3 6NP UK

Department of Anaesthesia and Intensive Care IRCCS San Raffaele Scientific Institute Milan Italy

Department of Cardiology Odense University Hospital Odense Denmark

Department of Cardiology Pulmonology and Vascular Medicine University Hospital Düsseldorf Medical Faculty of the Heinrich Heine University Düsseldorf Düsseldorf Germany

Department of Cardiology Rigshospitalet Copenhagen University Hospital Copenhagen Denmark

Department of Cardiovascular Diseases University Hospitals Leuven Herestraat 49 3000 Leuven Belgium

Department of Cardiovascular Sciences KU Leuven Herestraat 49 3000 Leuven Belgium

Department of Pulmonology and Vascular Medicine Cardiovascular Research Institute Düsseldorf Düsseldorf Germany

Groupe Cardio Vasculaire Interventionnel Clinique Pasteur Toulouse France

Zobrazit více v PubMed

Bernhardt  AM, Copeland  H, Deswal  A, Gluck  J, Givertz  MM. The International Society for Heart and Lung Transplantation/Heart Failure Society of America guideline on acute mechanical circulatory support. J Heart Lung Transplant  2023;42:e1–e64. PubMed

Møller  JE, Sionis  A, Aissaoui  N, Ariza  A, Bělohlávek  J, De Backer  D. et al.  Step by step daily management of short-term mechanical circulatory support for cardiogenic shock in adults in the intensive cardiac care unit: a clinical consensus statement of the Association for Acute CardioVascular Care of the European Society of Cardiology SC, the European Society of Intensive Care Medicine, the European branch of the Extracorporeal Life Support Organization, and the European Association for Cardio-Thoracic Surgery. Eur Hear Journal Acute Cardiovasc Care  2023;12:475–485. PubMed

Rossello  X, Vila  M, Rivas-Lasarte  M, Ferrero-Gregori  A, Sans-Roselló  J, Duran-Cambra  A, et al.  Impact of pulmonary artery catheter use on short- and long-term mortality in patients with cardiogenic shock. Cardiology  2017;136:61–69. PubMed

Tehrani  BN, Truesdell  AG, Sherwood  MW, Desai  S, Tran  HA, Epps  KC, et al.  Standardized team-based care for cardiogenic shock. J Am Coll Cardiol  2019;73:1659–1669. PubMed

Coletti  K, Griffiths  M, Nies  M, Brandal  S, Everett  AD, Bembea  MM. Cardiac dysfunction biomarkers are associated with potential for successful separation from extracorporeal membrane oxygenation in children. ASAIO J  2023;69:198–204. PubMed PMC

Heise  G, Lemmer  J, Weng  Y, Hübler  M, Alexi-Meskishvili  V, Böttcher  W, et al.  Biomarker responses during mid-term mechanical cardiac support in children. J Hear Lung Transplant  2008;27:150–157. PubMed

Jarai  R, Fellner  B, Haoula  D, Jordanova  N, Heinz  G, Karth  GD, et al.  Early assessment of outcome in cardiogenic shock: relevance of plasma N-terminal pro-B-type natriuretic peptide and interleukin-6 levels. Crit Care Med  2009;37:1837–1844. PubMed

Lindholm  MG, Hongisto  M, Lassus  J, Spinar  J, Parissis  J, Banaszewski  M, et al.  Serum lactate and a relative change in lactate as predictors of mortality in patients with cardiogenic shock—results from the CardShock study. Shock  2020;53:43–49. PubMed

Vandenbriele  C, Arachchillage  DJ, Frederiks  P, Giustino  G, Gorog  DA, Gramegna  M, et al.  Anticoagulation for percutaneous ventricular assist device-supported cardiogenic shock: JACC review topic of the week. J Am Coll Cardiol  2022;79:1949–1962. PubMed

Baldetti  L, Beneduce  A, Romagnolo  D, Frias  A, Gramegna  M, Sacchi  S. et al.  Impella malrotation within the left ventricle is associated with adverse in-hospital outcomes in cardiogenic shock. Cardiovasc Interv  2023;16:739–741. PubMed

Nakamura  M, Imamura  T, Fukui  T, Hori  M, Ueno  Y, Uen  H, et al.  Impact of the angle between aortic and mitral annulus on the occurrence of hemolysis during Impella support. J Artif Organs  2020;23:207–213. PubMed

Balthazar  T, Vandenbriele  C, Verbrugge  FH, Den Uil  C, Engström  A, Janssens  S, et al.  Managing patients with short-term mechanical circulatory support: JACC review topic of the week. J Am Coll Cardiol  2021;77:1243–1256. PubMed

Garan  AR, Kanwar  M, Thayer  KL, Whitehead  E, Zweck  E, Hernandez-Montfort  J. et al.  Complete hemodynamic profiling with pulmonary artery catheters in cardiogenic shock is associated with lower in-hospital mortality. Heart Fail  2020;8:903–913. PubMed

O’Neill  WW, Grines  C, Schreiber  T, Moses  J, Maini  B, Dixon  SR, et al.  Analysis of outcomes for 15,259 US patients with acute myocardial infarction cardiogenic shock (AMICS) supported with the Impella device. Am Heart J  2018;202:33–38. PubMed

Tavazzi  G, Alviar  CL, Colombo  CNJ, Dammassa  V, Price  S, Vandenbriele  C. How to unload the left ventricle during veno-arterial extracorporeal membrane oxygenation. Eur Hear J Cardiovasc Imaging  2023;24:696–698. PubMed

Donker  DW, Sallisalmi  M, Broomé  M. Right-left ventricular interaction in left-sided heart failure with and without venoarterial extracorporeal membrane oxygenation support—a simulation study. ASAIO J  2021;67:297. PubMed PMC

Saxena  A, Garan  AR, Kapur  NK, O’Neill  WW, Lindenfeld  J, Pinney  SP, et al.  Value of hemodynamic monitoring in patients with cardiogenic shock undergoing mechanical circulatory support. Circulation  2020;141:1184–1197. PubMed

Cheng  R, Hachamovitch  R, Kittleson  M, Patel  J, Arabia  F, Moriguchi  J, et al.  Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg  2014;97:610–616. PubMed

Falk  L, Sallisalmi  M, Lindholm  JA, Lindfors  M, Frenckner  B, Broomé  M, et al.  Differential hypoxemia during venoarterial extracorporeal membrane oxygenation. Perfusion  2019;34:22–29. PubMed

Chanan  EL, Bingham  N, Smith  DE, Nunnally  ME. Early detection, prevention, and management of acute limb ischemia in adults supported with venoarterial extracorporeal membrane oxygenation. J Cardiothorac Vasc Anesth  2020;34:3125–3132. PubMed

Charbonneau  F, Chahinian  K, Bebawi  E, Lavigueur  O, Lévesque  É, Lamarche  Y, et al.  Parameters associated with successful weaning of veno-arterial extracorporeal membrane oxygenation: a systematic review. Crit Care  2022;26:1–23. PubMed PMC

Gjesdal  G, Braun  O, Smith  JG, Scherstén  F, Tydén  P. Blood lactate is a predictor of short-term mortality in patients with myocardial infarction complicated by heart failure but without cardiogenic shock. BMC Cardiovasc Disord  2018;18:1–8. PubMed PMC

Bertoldi  LF, Delmas  C, Hunziker  P, Pappalardo  F. Escalation and de-escalation of mechanical circulatory support in cardiogenic shock. Eur Heart J Suppl  2021;23:A35–A40. PubMed PMC

Nakamura  M, Imamura  T. Practical management of ECPELLA. Int Heart J  2020;61:1094–1096. PubMed

Kochav  SM, Flores  RJ, Truby  LK, Topkara  VK. Prognostic impact of pulmonary artery pulsatility index (PAPi) in patients with advanced heart failure: insights from the ESCAPE trial. J Card Fail  2018;24:453–459. PubMed

Bertoldi  LF, Bertoglio  L, Pappalardo  F. Concomitant use of Impella while on peripheral veno-arterial extracorporeal membrane oxygenation: de-escalate and ambulate. Ann Cardiothorac Surg  2019;8:160–162. PubMed PMC

Esposito  ML, Jablonski  J, Kras  A, Krasney  S, Kapur  NK. Maximum level of mobility with axillary deployment of the Impella 5.0 is associated with improved survival. Int J Artif Organs  2018;41:236–239. PubMed

Tschöpe  C, Van Linthout  S, Klein  O, Mairinger  T, Krackhardt  F, Potapov  EV, et al.  Mechanical unloading by fulminant myocarditis: LV-IMPELLA, ECMELLA, BI-PELLA, and PROPELLA concepts. J Cardiovasc Transl Res  2019;12:116–123. PubMed PMC

Tavazzi  G, Corradi  F, Vandenbriele  C, Alviar  CL. Multimodality imaging in cardiogenic shock: state-of-the art. Curr Opin Crit Care  2023;29:381–391. PubMed

Kadosh  BS, Berg  DD, Bohula  EA, Park  JG, Baird-Zars  VM, Alviar  C, et al.  Pulmonary artery catheter use and mortality in the cardiac intensive care unit. JACC Hear Fail  2023;11:903–914. PubMed PMC

Van Diepen  S, Katz  JN, Albert  NM, Henry  TD, Jacobs  AK, Kapur  NK, et al.  Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation  2017;136:e232-68. PubMed

Balthazar  T, Vandenbriele  C. Handbook on mechanical circulatory support: part 9 Impella troubleshooting and resuscitation. Eur Soc Cardiol  2022; pp. 112–125. Available at:  https://www.escardio.org/static-file/Escardio/Subspecialty/ACCA/Publications/ACVCHandbookMCS2022/ESC-HandbookMCS-IMPELLATROUBLESHOOTINGANDRESUSCITATION.pdf