Best Management Practices on Temporary Mechanical Circulatory Support: Joint Consensus Report of the PeriOperative Quality Initiative and the Enhanced Recovery After Surgery Cardiac Society.

Abstract

Background: Effective utilization of temporary mechanical circulatory support (tMCS) mandates a multifaceted understanding of patient physiology, device technology, procedural techniques, patient-device interactions, and interdisciplinary collaboration. This manuscript endeavours to provide clinicians with a practical roadmap incorporating evidence-based best practices in several key areas that delineate the initial priorities in mechanical ventilation, anticoagulation, sedation, and monitoring for patients requiring tMCS.

Methods: With an interdisciplinary, international group of clinicians and through a structured literature review, a modified Delphi method was used to achieve consensus on best practices in tMCS.

Results: Nine key questions were developed with accompanying statements to direct areas that institutions and providers should prioritize to optimize care. These questions included: what expertise is required within the interdisciplinary team to optimize patient care? How should medical centers facilitate escalation of care when indicated? What is the optimal ventilation management strategy? What are the recommended gas exchange targets to preserve end-organ function? What is the recommended timing to start or resume anticoagulation? What anticoagulation agent and monitoring approach should be used routinely? What is the optimal strategy for patient comfort and device interactions? Can a patient on tMCS be mobilized? What routine monitoring needs to be performed?

Conclusions: This review provides a comprehensive review of key management strategies leveraging the interdisciplinary team and evidence-based medical knowledge to improve patient outcomes while utilizing tMCS.