Echography monitoring in patients with temporary mechanical circulatory support

To examine the role of echocardiography in managing patients with refractory cardiogenic shock supported by temporary mechanical circulatory support (t-MCS) and provide practical recommendations to improve clinical practice.

t-MCS devices are increasingly used to stabilize patients with refractory cardiogenic shock. Echocardiography, due to its accessibility and ability to assess both structural and functional aspects of heart failure, is ideally suited for daily bedside evaluation of cardiac function and t-MCS-myocardial interactions.

From t-MCS initiation to liberation, echocardiography is essential to guide clinical decision-making. It aids in selecting the most appropriate t-MCS device, ensuring optimal positioning, and fine-tuning flow parameters in real-time based on native cardiac function and patient needs. Additionally, echocardiography is critical for identifying intracardiac complications and directing unloading strategies in venoarterial extracorporeal membrane oxygenation, particularly with very low residual ejection or aortic valve closure. Finally, the weaning process should be informed by comprehensive echocardiographic evaluations, aligned with international guidelines. These steps are outlined in this review, accompanied by clear and practical recommendations to enhance clinical practice.