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

Area of Science:

• Cardiology
• Medical Imaging
• Critical Care Medicine

Background:

• Short-term mechanical circulatory support (stMCS) devices are crucial for hemodynamic stabilization in cardiogenic shock.
• Echocardiography is essential throughout the stMCS device lifecycle, including selection, implantation, monitoring, and weaning.

Purpose of the Study:

• To provide a comprehensive, practical guide for clinicians on echocardiographic assessment of stMCS devices.
• To standardize echocardiographic practices for stMCS management and enhance clinical outcomes in critically ill cardiac patients.

Main Methods:

• Review of commonly used stMCS devices: intra-aortic balloon pump, Impella, ProtekDuo, and veno-arterial extracorporeal membrane oxygenation.
• Outline of device-specific contraindications, key imaging views for placement guidance, and performance monitoring parameters.
• Introduction of structured echocardiographic criteria for weaning and explantation decisions.

Main Results:

• Detailed echocardiographic assessment strategies for various stMCS devices.
• Identification of parameters for monitoring device function and detecting complications.
• Exploration of emerging technologies like 3D imaging and AI for stMCS optimization.

Conclusions:

• Standardized echocardiographic assessment is vital for effective stMCS management.
• This guide aims to improve clinical decision-making and patient outcomes in cardiogenic shock.
• Future directions include integrating advanced imaging and AI for enhanced stMCS care.