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Practice Guideline
. 2025 Aug;120(2):194-201.
doi: 10.1016/j.athoracsur.2025.03.024. Epub 2025 Apr 2.

Temporary Mechanical Circulatory Support in Cardiogenic Shock: Executive Summary of the Joint Consensus Reports of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society

Michael C Grant  1 , Manreet K Kanwar  2 , Audrey E Spelde  3 , Subhasis Chatterjee  4 , Jean Deschamps  5 , Rakesh C Arora  6 , Andrew D Shaw  5 , Daniel T Engelman  7 ; PeriOperative Quality Initiative (POQI) and the Enhanced Recovery After Surgery (ERAS) Cardiac Society workgroup
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Practice Guideline

Temporary Mechanical Circulatory Support in Cardiogenic Shock: Executive Summary of the Joint Consensus Reports of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society

Michael C Grant et al. Ann Thorac Surg. 2025 Aug.
Free article

Abstract

Background: The identification, triage, and management of cardiogenic shock (CS) are complex and resource intensive, particularly given the recent surge in the use of temporary mechanical circulatory support (tMCS) devices. This document is an executive summary of a series of consensus statements that guide the bedside clinician regarding the management of tMCS in the setting of CS.

Methods: The PeriOperative Quality Initiative (POQI) and Enhanced Recovery After Surgery (ERAS) Cardiac Society convened an interdisciplinary, international panel of experts and used a structured appraisal of the literature and the modified Delphi method to derive consensus on a series of topics related to both CS and tMCS.

Results: The effort resulted in 3 manuscripts with guidance related to the diagnosis, escalation or de-escalation, and best practices associated with CS and the provision of tMCS. Group consensus was derived around existing clinical questions, summary guidance statements, and the quality of the existing evidence.

Conclusions: The POQI/ERAS cardiac consensus series derived 27 unique statements regarding the care of patients with CS and the provision of tMCS. Key themes emerged, including the need for immediate and systematic assessment of CS severity, early initiation of tMCS, an algorithmic approach to the escalation and de-escalation of tMCS therapies, and adoption of high-quality best practices associated with tMCS management.

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Conflict of interest statement

Disclosures Michael C. Grant is on the editorial board of The Society of Thoracic Surgeons (STS) journals (The Annals of Thoracic Surgery); and is on the editorial board of The Journal of Thoracic and Cardiovascular Surgery (JTCVS). Manreet K. Kanwar reports a relationship with Abiomed that includes: consulting or advisory; and with Abbott that includes: consulting or advisory. Subhasis Chatterjee reports a relationship with Edwards Lifesciences that includes: consulting or advisory; with Baxter that includes: consulting or advisory; with La Jolla that includes: consulting or advisory; and with Eagle that includes: consulting or advisory. Rakesh C. Arora reports a relationship with Edwards Lifesciences that includes: speaking and lecture fees; with HLS Therapeutics that includes: speaking and lecture fees; with Bioporto that includes: speaking and lecture fees; with Renibus Therapeutics that includes: consulting or advisory; and with Alexion that includes: consulting or advisory; and is on the editorial board of The Journal of Thoracic and Cardiovascular Surgery (JTCVS). Andrew D. Shaw reports a relationship with Alexion that includes: consulting or advisory; with Chugai that includes: consulting or advisory; with Retia Medical LLC that includes: consulting or advisory; with Renibus Therapeutics that includes: consulting or advisory; with Novartis that includes: consulting or advisory; with RenalGuard Solutions that includes: consulting or advisory; with CalciMedica that includes: consulting or advisory; and with Fresenius SE & Co KGaA that includes: consulting or advisory. Daniel T. Engelman reports a relationship with Edwards Lifesciences that includes: consulting or advisory; with Renibus Therapeutics that includes: consulting or advisory; with Alexion that includes: consulting or advisory; with Genentech that includes: consulting or advisory; with RenalGuard Solutions that includes: consulting or advisory; with Medela that includes: consulting or advisory; with Arthrex that includes: consulting or advisory; with AtriCure that includes: consulting or advisory; and with Bayer that includes: consulting or advisory; and is on the editorial board of STS journals (The Annals of Thoracic Surgery). Audrey E. Spelde and Jean Deschamps declare that they have no conflicts of interest.

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