Escalation and De-escalation of Temporary Mechanical Circulatory Support: Joint Consensus Report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society
Author Department
Surgery
Document Type
Article, Peer-reviewed
Publication Date
4-2025
Abstract
Background: Temporary mechanical circulatory support (tMCS) for cardiogenic shock (CS) is increasing despite knowledge gaps and variations in management practices. This document was created to provide clinicians with guidance regarding initiation, escalation and de-escalation of tMCS in patients with CS.
Methods: An interdisciplinary, international expert panel utilizing a structured literature appraisal and modified Delphi method derived consensus statements regarding triggers for prompt patient assessment and initiating tMCS in CS, assessing adequacy of support, readiness for tMCS weaning and next steps in non-recovery. Individual statements were graded based on the quality of available evidence.
Results: The panel addressed four main questions aimed at initiation, escalation and de-escalation of tMCS. Based on available literature review and expert consensus, 11 recommendations were formulated. Key principles included recognition of the need for CS patients with ongoing hemodynamic compromise, tissue hypoperfusion, and metabolic derangements to be considered for early tMCS initiation. An interdisciplinary shock team should be involved in management with early referral when patient conditions require care beyond center capabilities. Discussions providing anticipatory guidance should be performed with patients and decision makers prior to initiating tMCS. Management of tMCS involves frequent, timely hemodynamic and tissue perfusion reassessments to determine the need for escalation or weaning. For patients unable to wean from tMCS, evaluation should include interdisciplinary assessment for advanced therapies with palliation included as a consideration in care discussions.
Conclusions: A practical guide to initiation, escalation, and de-escalation of temporary MCS is provided. Center-specific approaches based on local capabilities should be implemented.
Recommended Citation
Spelde AE, Barron LM, Cangut B, Hickey GW, Lorusso R, Silvestry SC, Tong MZ, Engelman DT, Shaw AD, Chatterjee S; PeriOperative Quality Initiative (POQI) and the Enhanced Recovery After Surgery® (ERAS) Cardiac Society Workgroup. Escalation and De-escalation of Temporary Mechanical Circulatory Support: Joint Consensus Report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society. Ann Thorac Surg. 2025 Apr 3:S0003-4975(25)00286-3. doi: 10.1016/j.athoracsur.2025.01.038. Epub ahead of print.
PMID
40187586