Indications and management of MCS

Temporary MCS was indicated for patients with cardiogenic shock and persistent hemodynamic instability despite initial management with vasopressors and/or revascularization when needed. Hemodynamic instability was defined as a systolic blood pressure ≤ 90 mmHg despite inotrope/vasopressor support, signs of end-organ failure (clammy skin, capillary filling time > 3 s, urine output < 0.5 mL/kg/h, lactate level > 4 mmol/L), and low cardiac output (< 2.2 L/min/m² if receiving inotropes/vasopressors or < 1.8 L/min/m² without inotropes/vasopressors).

Impella CP^® (Abiomed Europe GmbH, Aachen, Germany) and VA-ECMO (MAQUET Holding B.V.& Co. KG, Rastatt, Germany) were available at all centers. Among patients with clinical indications for MCS, the etiologies of cardiogenic shock included acute myocardial infarction, acute decompensated heart failure, postcardiotomy shock, primary allograft dysfunction after heart transplantation, and myocarditis. Selection of the MCS device and overall patient management were left at the discretion of each center, according to clinical indication and center experience. All participating centers were trained in MCS indication and management according to current guidelines and ELSO (Extracorporeal Life Support Organization) [16].