Monitoring MCS patients on the intensive care unit: integrating haemodynamic assessment, laboratory data, and imaging techniques for timely detection of deterioration and recovery.

Monitoring of the patient supported with a temporary mechanical circulatory support (tMCS) is crucial in achieving the best possible outcome. Monitoring is a continuous and labour-intensive process, as cardiogenic shock (CS) patients can rapidly deteriorate and may require new interventions within a short time period. Echocardiography and invasive haemodynamic monitoring form the cornerstone of successful tMCS support. During monitoring, it is particularly important to ensure that adequate end-organ perfusion is achieved and maintained. Here, we provide a comprehensive overview of best practices for monitoring the CS patient supported by a micro-axial flow pump, veno-arterial extracorporeal membrane oxygenation, and both devices simultaneously (ECMELLA approach). It is a complex process that encompasses device control, haemodynamic control and stabilization, monitoring of interventions, and assessment of end-organ function. The combined, continuous, and preferably protocol-based approach of echocardiography, evaluation of biomarkers, end-organ assessment, and haemodynamic parameters is crucial in assessing this critically ill CS patient population.
Competing Interests: Conflict of interest: C.V. received manuscript support from Abiomed, honoraria from Abiomed, and travel support from Abiomed. C.V. is supported by a research grant of the FWO-flanders (FKM 1803923N). J.B. is on a board for AstraZeneca and BoehringerIngelheim and received consulting fees from Abiomed, Getinge, Resuscitec, and Xenios. C.H. has received research grants from Novo Nordisk Foundation, Lundbeck Foundation, and Danish Heart Foundation and honoraria from Abiomed and is in an unpaid leadership role as Chair of the Danish Heart Foundation and board member of ESC. M.P. has received manuscript preparation support, consulting fees, and honoraria from Abiomed. A.P. has received manuscript preparation support from Abiomed, a research grant from the German Research Council, and honoraria from Abbott, Bayer, Bristol-Myers Squibb, Pfizer, Daiichi, and Medtronic. M.S. reports no disclosures or conflicts of interest. J.E.M. has received grants from Abiomed and Novo Nordic, honoraria from Abiomed, Boehringer Ingelheim, Abbott, and Orion, and travel support from Abiomed.
(© The Author(s) 2023. Published by Oxford University Press on behalf of the European Society of Cardiology.)