Mechanical Circulatory Support/ECMO Indications — free guideline decision tool
This tool guides selection of mechanical circulatory support (IABP, Impella, VA-ECMO, or RV assist) in cardiogenic shock by the type of failure, integrating recent randomized trials and 2023 ESC / 2025 ACC/AHA recommendations.
Open guideline tool →Guideline-based
Implements the decision logic from published clinical guidelines.
Runs in your browser
No installation. Enter the patient's values and get a guideline recommendation instantly.
Data stays local
Nothing is uploaded. Results are for licensed clinicians only.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Type of failure/shock | Refractory shock/cardiac arrest/combined cardiopulmonary failure |
|---|
→MCS recommendationVA-ECMO (with LV unloading if needed)
- Recommended direction：Refractory shock/cardiac arrest (ECPR)/severe biventricular or combined cardiopulmonary failure: VA-ECMO provides combined cardiopulmonary support. ECLS-SHOCK (2023) showed routine early VA-ECMO did not lower AMI-CS mortality and increased complications → 2025 ACC/AHA recommends against routine use ([pending update]); 2023 ESC [pending update] for refractory CS after IABP/Impella failure. VA-ECMO increases LV afterload and often needs LV unloading (ECPELLA = Impella + ECMO, or ECMO + IABP)
- Overall principle：At present no tMCS device has a [pending update] recommendation; benefit is limited to selected subgroups. Emphasize early recognition (SCAI stage + lactate + neurologic status), timely referral to experienced centers, individualized selection by failure type and center experience, and planning a weaning/escalation strategy
- Basis：IABP-SHOCK II 2012; ECLS-SHOCK 2023; DanGer Shock 2024; 2023 ESC ACS guidelines; 2025 ACC/AHA ACS guidelines
| Type of failure/shock | Isolated LV failure (e.g. STEMI-related severe/refractory CS) |
|---|
→MCS recommendationImpella (micro-axial flow pump)
- Recommended direction：Isolated LV failure, STEMI-related severe/refractory CS: DanGer Shock (2024) showed Impella CP improves survival in STEMI-CS (but with more bleeding/hemolysis/AKI/limb ischemia) → 2025 ACC/AHA raised the recommendation (class [pending update]) (STEMI severe/refractory shock, experienced centers). IABP is not recommended routinely (IABP-SHOCK II neutral; class [pending update]). Contraindications: mechanical aortic valve, severe AS, LV thrombus, severe peripheral vascular disease, VSD
- Overall principle：At present no tMCS device has a [pending update] recommendation; benefit is limited to selected subgroups. Emphasize early recognition (SCAI stage + lactate + neurologic status), timely referral to experienced centers, individualized selection by failure type and center experience, and planning a weaning/escalation strategy
- Basis：IABP-SHOCK II 2012; ECLS-SHOCK 2023; DanGer Shock 2024; 2023 ESC ACS guidelines; 2025 ACC/AHA ACS guidelines
Common questions
What is Mechanical Circulatory Support/ECMO Indications?
This tool guides selection of mechanical circulatory support (IABP, Impella, VA-ECMO, or RV assist) in cardiogenic shock by the type of failure, integrating recent randomized trials and 2023 ESC / 2025 ACC/AHA recommendations.
How is Mechanical Circulatory Support/ECMO Indications calculated? What is the core formula?
Decision logic by failure type: isolated LV → Impella (STEMI severe/refractory, [pending update]); refractory/arrest/cardiopulmonary failure → VA-ECMO ± LV unloading (against routine use; [pending update] for refractory); RV/biventricular → RV assist or VA-ECMO; mechanical complication → IABP bridge.
When is Mechanical Circulatory Support/ECMO Indications used?
Use at the bedside in cardiogenic shock to match the device to the failure pattern — isolated LV, refractory/arrest, RV/biventricular, or mechanical complication — while emphasizing early recognition, referral to experienced centers, and a planned weaning/escalation strategy.
What are the key clinical points for Mechanical Circulatory Support/ECMO Indications?
No temporary MCS device holds a [pending update] recommendation; benefit is limited to selected subgroups, so device choice should be individualized by failure type and center experience. (original synthesis · not guideline verbatim) DanGer Shock (2024) supported Impella in STEMI-CS (raised the recommendation (class [pending update])) at a cost of more bleeding, hemolysis, AKI, and limb ischemia. ECLS-SHOCK (2023) found routine early VA-ECMO did not reduce AMI-CS mortality and increased complications; VA-ECMO often needs LV unloading.
What are the limits and cautions when using Mechanical Circulatory Support/ECMO Indications?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
Does Mechanical Circulatory Support/ECMO Indications upload patient data? Where is it calculated?
Calculation runs locally in the browser; inputs and results are not uploaded. For licensed clinicians only; interpret with history, investigations and local protocols — not a diagnosis or prescription.
How is Mechanical Circulatory Support/ECMO Indications calculated in practice? Can you show a worked example?
Inputs: Type of failure/shock Refractory shock/cardiac arrest/combined cardiopulmonary failure → Result: MCS recommendation VA-ECMO (with LV unloading if needed)（Recommended direction: Refractory shock/cardiac arrest (ECPR)/severe biventricular or combined cardiopulmonary failure: VA-ECMO provides combined cardiopulmonary support. ECLS-SHOCK (2023) showed routine early VA-ECMO did not lower AMI-CS mortality and increased complications → 2025 ACC/AHA recommends against routine use ([pending update]); 2023 ESC [pending update] for refractory CS after IABP/Impella failure. VA-ECMO increases LV afterload and often needs LV unloading (ECPELLA = Impella + ECMO, or ECMO + IABP), Overall principle: At present no tMCS device has a [pending update] recommendation; benefit is limited to selected subgroups. Emphasize early recognition (SCAI stage + lactate + neurologic status), timely referral to experienced centers, individualized selection by failure type and center experience, and planning a weaning/escalation strategy, Basis: IABP-SHOCK II 2012; ECLS-SHOCK 2023; DanGer Shock 2024; 2023 ESC ACS guidelines; 2025 ACC/AHA ACS guidelines） Inputs: Type of failure/shock Isolated LV failure (e.g. STEMI-related severe/refractory CS) → Result: MCS recommendation Impella (micro-axial flow pump)（Recommended direction: Isolated LV failure, STEMI-related severe/refractory CS: DanGer Shock (2024) showed Impella CP improves survival in STEMI-CS (but with more bleeding/hemolysis/AKI/limb ischemia) → 2025 ACC/AHA raised the recommendation (class [pending update]) (STEMI severe/refractory shock, experienced centers). IABP is not recommended routinely (IABP-SHOCK II neutral; class [pending update]). Contraindications: mechanical aortic valve, severe AS, LV thrombus, severe peripheral vascular disease, VSD, Overall principle: At present no tMCS device has a [pending update] recommendation; benefit is limited to selected subgroups. Emphasize early recognition (SCAI stage + lactate + neurologic status), timely referral to experienced centers, individualized selection by failure type and center experience, and planning a weaning/escalation strategy, Basis: IABP-SHOCK II 2012; ECLS-SHOCK 2023; DanGer Shock 2024; 2023 ESC ACS guidelines; 2025 ACC/AHA ACS guidelines）
Run Mechanical Circulatory Support/ECMO Indications now
This tool guides selection of mechanical circulatory support (IABP, Impella, VA-ECMO, or RV assist) in cardiogenic shock by the type of failure, integrating recent randomized trials and 2023 ESC / 2025 ACC/AHA recommendations.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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