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

Journal: European heart journal. Imaging methods and practice
Published Date: Jun 10, 2025

Abstract

Short-term mechanical circulatory support (stMCS) devices are increasingly utilized for haemodynamic stabilization in patients with cardiogenic shock. Echocardiography plays a pivotal role across the continuum of stMCS use-from patient selection and device implantation to monitoring, troubleshooting, and weaning. This review provides a comprehensive, practical guide for clinicians on the echocardiographic assessment of commonly used stMCS devices, including intra-aortic balloon pump, Impella, ProtekDuo, and veno-arterial extracorporeal membrane oxygenation. We outline device-specific contraindications, key imaging views for guiding placement, and parameters for monitoring device performance and detecting complications. The paper also introduces structured echocardiographic criteria to support decision-making during weaning and explantation. Finally, we explore emerging tools such as speckle-tracking echocardiography, 3D imaging, and artificial intelligence that may further optimize stMCS management. Through an international, multidisciplinary collaboration, this guide aims to standardize echocardiographic practice in stMCS and improve clinical outcomes in critically ill cardiac patients.

Authors

  • Hatem Soliman-Aboumarie
    Department of Cardiothoracic Anaesthesia, Intensive Care, Mechanical Circulatory Support and Transplantation, Harefield Hospital, Royal Brompton and Harefield Hospitals, Hill End Road, Uxbridge, London UB96JH, UK.
  • Christophe Vandenbriele
    Department of Cardiothoracic Anaesthesia, Intensive Care, Mechanical Circulatory Support and Transplantation, Harefield Hospital, Royal Brompton and Harefield Hospitals, Hill End Road, Uxbridge, London UB96JH, UK.
  • Luca Baldetti
    Cardiac Intensive Care Unit, San Raffaele Hospital, Via Olgettina, 60 Milan 20132, Italy.
  • Tim Balthazar
    Department of Intensive Care Medicine, University Hospital Brussels, Brussels, Belgium.
  • Sascha Ott
    Department of Cardiac Anaesthesiology and Intensive Care Medicine, Deutsches Herzzentrum der Charité, Berlin, Germany.
  • Jaime Hernandez-Montfort
    Advanced Heart Disease Program, Baylor Scott and White Health, Temple, TX, USA.
  • Alina Nicoara
    Department of Anesthesiology, Duke University, Durham, NC, USA.

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