Echocardiography for short-term mechanical circulatory support: a trans-Atlantic practical guide

Short-term mechanical circulatory support (stMCS) devices are increasingly utilized for haemodynamic stabilization in patients with cardiogenic shock. Echocardiography plays a pivotal role across the continuum of stMCS use-from patient selection and device implantation to monitoring, troubleshooting, and weaning. This review provides a comprehensive, practical guide for clinicians on the echocardiographic assessment of commonly used stMCS devices, including intra-aortic balloon pump, Impella, ProtekDuo, and veno-arterial extracorporeal membrane oxygenation. We outline device-specific contraindications, key imaging views for guiding placement, and parameters for monitoring device performance and detecting complications. The paper also introduces structured echocardiographic criteria to support decision-making during weaning and explantation. Finally, we explore emerging tools such as speckle-tracking echocardiography, 3D imaging, and artificial intelligence that may further optimize stMCS management. Through an international, multidisciplinary collaboration, this guide aims to standardize echocardiographic practice in stMCS and improve clinical outcomes in critically ill cardiac patients.