Current practices in the management of temporary mechanical circulatory support: A survey of CICU directors in North America

Amrita Balgobind¹, Matthew Pierce², Carlos Alviar³, Christopher Barnett⁴, Gregory Barsness⁵, Sunit-Preet Chaudhry⁶, Meshe Chonde⁷, Howard Cooper⁸, Lori Daniels⁹, Umesh Gidwani¹⁰, Christopher Fordyce¹¹, Michael Goldfarb¹², Jason N Katz³, Michael Kontos¹³, Younghoon Kwon¹⁴, Evan Liebner¹⁵, Shuangbo Liu¹⁶, P Elliott Miller¹⁷, L K Newby¹⁸, Connor O'Brien⁴, Alexander Papolos¹⁹, Barbara Pisani²⁰, Brian Potter²¹, Alastair Proudfoot²², Robert O Roswell²³, Shashank S Sinha²⁴, Timothy D Smith²⁵, Andrea D Thompson²⁶, Sean van Diepen²⁷, Sammy Zakaria²⁸, David Morrow²⁹, Miguel Alvarez Villela³⁰

Affiliations

¹ Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
² Northwell, New Hyde Park, Cardiovascular Institute, NY.
³ Department of Medicine at New York University Grossman School of Medicine, Bellevue Hospital, New York, New York, NY.
⁴ Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA.
⁵ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
⁶ Saint Vincent Heart Center, Indianapolis, IN.
⁷ Department of Cardiology, Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA.
⁸ Westchester Medical Center and New York Medical College, Valhalla.
⁹ Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla.
¹⁰ Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, NY.
¹¹ University of British Columbia, University of British Columbia Centre for Cardiovascular Innovation, Cardiovascular Health Program, University of British Columbia Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC.
¹² Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
¹³ Division of Cardiology, Virginia Commonwealth University, Richmond, VA.
¹⁴ Division of Cardiology University of Washington Seattle, WA.
¹⁵ Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, NY.
¹⁶ Max Rady College of Medicine, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
¹⁷ Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
¹⁸ Division of Cardiology, Duke University School of Medicine, Durham, NC.
¹⁹ Departments of Cardiology and Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC.
²⁰ Atrium Wake Forest Baptist, Winston-Salem, NC.
²¹ Centre Hospitalier de l'Université de Montréal Research Center and Cardiovascular Center, Quebec, Canada.
²² Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, London.
²³ Northwell, New Hyde Park, Cardiovascular Institute, NY; Lenox Hospital, Northwell Health, New York, New York.
²⁴ Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA.
²⁵ The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH.
²⁶ Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
²⁷ Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
²⁸ Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
²⁹ Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
³⁰ Northwell, New Hyde Park, Cardiovascular Institute, NY; Lenox Hospital, Northwell Health, New York, New York; Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Electronic address: miguel.alvarez.vil@gmail.com.

PMID: 39182940
PMCID: PMC12118638 (available on 2025-10-01)
DOI: 10.1016/j.ahj.2024.05.018

Current practices in the management of temporary mechanical circulatory support: A survey of CICU directors in North America

Amrita Balgobind et al. Am Heart J. 2024 Oct.

. 2024 Oct:276:115-119.

doi: 10.1016/j.ahj.2024.05.018. Epub 2024 Jul 30.

Authors

Affiliations

¹ Department of Internal Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY.
² Northwell, New Hyde Park, Cardiovascular Institute, NY.
³ Department of Medicine at New York University Grossman School of Medicine, Bellevue Hospital, New York, New York, NY.
⁴ Division of Cardiology, Department of Medicine, University of California San Francisco, San Francisco, CA.
⁵ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
⁶ Saint Vincent Heart Center, Indianapolis, IN.
⁷ Department of Cardiology, Department of Cardiac Surgery, Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA.
⁸ Westchester Medical Center and New York Medical College, Valhalla.
⁹ Division of Cardiovascular Medicine, Department of Medicine, University of California San Diego, La Jolla.
¹⁰ Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, NY.
¹¹ University of British Columbia, University of British Columbia Centre for Cardiovascular Innovation, Cardiovascular Health Program, University of British Columbia Centre for Health Evaluation and Outcomes Sciences, Vancouver, BC.
¹² Division of Cardiology, Jewish General Hospital, McGill University, Montreal, Quebec, Canada.
¹³ Division of Cardiology, Virginia Commonwealth University, Richmond, VA.
¹⁴ Division of Cardiology University of Washington Seattle, WA.
¹⁵ Department of Critical Care Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, NY; Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, The Mount Sinai Hospital, New York, New York, NY.
¹⁶ Max Rady College of Medicine, St. Boniface Hospital, Winnipeg, Manitoba, Canada.
¹⁷ Department of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT.
¹⁸ Division of Cardiology, Duke University School of Medicine, Durham, NC.
¹⁹ Departments of Cardiology and Critical Care Medicine, MedStar Washington Hospital Center, Washington, DC.
²⁰ Atrium Wake Forest Baptist, Winston-Salem, NC.
²¹ Centre Hospitalier de l'Université de Montréal Research Center and Cardiovascular Center, Quebec, Canada.
²² Perioperative Medicine Department, Barts Heart Centre, St Bartholomew's Hospital, London.
²³ Northwell, New Hyde Park, Cardiovascular Institute, NY; Lenox Hospital, Northwell Health, New York, New York.
²⁴ Inova Heart and Vascular Institute, Inova Fairfax Medical Center, Falls Church, VA.
²⁵ The Carl and Edyth Lindner Center for Research and Education, The Christ Hospital, Cincinnati, OH.
²⁶ Department of Internal Medicine, Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, MI.
²⁷ Division of Cardiology, Department of Critical Care Medicine, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
²⁸ Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
²⁹ Levine Cardiac Intensive Care Unit, TIMI Study Group, Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
³⁰ Northwell, New Hyde Park, Cardiovascular Institute, NY; Lenox Hospital, Northwell Health, New York, New York; Division of Cardiology, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY. Electronic address: miguel.alvarez.vil@gmail.com.

PMID: 39182940
PMCID: PMC12118638 (available on 2025-10-01)
DOI: 10.1016/j.ahj.2024.05.018

Abstract

Introduction: Despite the growing use of temporary mechanical circulatory support (tMCS), little data exists to inform management and weaning of these devices.

Methods: We performed an online survey among cardiac intensive care unit directors in North America to examine current practices in the management of patients treated with intraaortic balloon pump and Impella.

Results: We received responses from 84% of surveyed centers (n=37). Our survey focused on three key aspects of daily management: 1. Hemodynamic monitoring; 2. Hemocompatibility; and 3. Weaning and removal. We found substantial variability surrounding all three areas of care.

Conclusion: Our findings highlight the need for consensus around practices associated with improved outcomes in patients treated with tMCS.

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Conflict of interest statement

Declaration of Competing Interest Christopher Barnett receives research funding from Merck and is a consultant for Abiomed, Zoll, and Abbott. Michael Kontos is a consultant for Beckman Coulter. Barbara Pisani has self-funded personal investments in Abbott, Amgen, GlaxoSmithKline, Bristol Myers Squibb. Andrea Thompson is supported by NIH-NHLBI [K08HL163328]. The remaining authors have no conflicts of interests to declare.

References

1. Thiele H, Zeymer U, Neumann F, et al. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): final 12 month results of a randomised, open-label trial. Lancet 2013;382:1638–45. - PubMed
1. Karami M, Eriksen E, Ouweneel DM, et al. Long-term 5-year outcome of the randomized IMPRESS in severe shock trial: percutaneous mechanical circulatory support vs. intra-aortic balloon pump in cardiogenic shock after acute myocardial infarction. Eur Heart J Acute Cardiovasc Care 2021;10:1009–15. - PMC - PubMed
1. O’Neill WW, Kleiman NS, Moses J, et al. A prospective, randomized clinical trial of hemodynamic support with Impella 2.5 versus intra-aortic balloon pump in patients undergoing high-risk percutaneous coronary intervention: the PROTECT II study. Circulation 2012;126:1717–27. - PubMed
1. Moller JE, Engstrom T, Jensen LO, et al. Microaxial flow pump or standard care in infarct-related cardiogenic shock. N Engl J Med 2024;390:1382–93. - PubMed
1. Berg DD, Barnett CF, Kenigsberg BB, et al. Clinical practice patterns in temporary mechanical circulatory support for shock in the Critical Care Cardiology Trials Network (CCCTN) Registry. Circ Heart Fail 2019;12:e006635. - PMC - PubMed

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K08 HL163328/HL/NHLBI NIH HHS/United States

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Current practices in the management of temporary mechanical circulatory support: A survey of CICU directors in North America

Affiliations

Current practices in the management of temporary mechanical circulatory support: A survey of CICU directors in North America

Authors

Affiliations

Abstract

Conflict of interest statement

References

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources