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

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