🫀 Mechanical Circulatory Support/ECMO Indications
This tool guides selection of mechanical circulatory support (IABP, Impella, VA-ECMO, or RV assist) in cardiogenic shock by the type of failure, integrating recent randomized trials and 2023 ESC / 2025 ACC/AHA recommendations.
Mechanical Circulatory Support/ECMO Indications
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, IIa); refractory/arrest/cardiopulmonary failure → VA-ECMO ± LV unloading (against routine use; IIb for refractory); RV/biventricular → RV assist or VA-ECMO; mechanical complication → IABP bridge.
Key points
- No temporary MCS device holds a Class I 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 (upgraded to IIa) 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
- Møller JE, et al. (DanGer Shock). Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med 2024.
- Thiele H, et al. (ECLS-SHOCK). Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. N Engl J Med 2023.