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🫀 Mechanical Circulatory Support/ECMO Indications

UseUse at the bedside in cardiogenic shock to match the device to the failure pattern — isolated LV, refractory/…

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SourceMøller JE, et al. (DanGer Shock). Microaxial Flow Pump or Standard Care in Infarct-Related Cardioge…

Runs locally in your browser (no PHI uploaded). For licensed clinicians — not a substitute for clinical judgement.
Stored on this device for revisit reminders

This-shift next steps

After scoring: open the scene pack, peer scores, and the matching pathway. Local reference — no HIS write.

Scene next step
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Related scores
Score + version; reference only — not a substitute for care · no HIS write

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Methodology · worked example, guidelines & full notes
Clinical takeaway

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)

When to use

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.

How it works

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.

Key points

  • 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.

References

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/shockRefractory 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/shockIsolated 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
Verification & sources · governance
FAQ

Frequently asked questions

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）
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