Temporary Mechanical Circulatory Support (tMCS) Survey

Cardiogenic shock management is not currently standardised due to the absence of high level of evidence coming from randomised control studies. Nevertheless, mechanical circulatory support is increasingly used in the advanced SCAI stages to maintain/improve the haemodynamic to bridge the patient to different potential exit strategies.
There is no data regarding the different tMCS allocation and management except for high level academic centres contributing to network data collection or registries.
The aim of the current survey is to investigate, at investigator-driven level, management pathways of patient undertaking tMCS since the validation process to the weaning.
This is intended to frame similarities and differences across the different physicians who will respond to the survey. It may work as first-step to implement future research aiming at gathering patient's data from centres which will be potentially willing to participate to inception studies and, ultimately, filling the gaps

Disclaimer

Your participation is anonymous. We will not disclose your identity to any third party.
We comply with the European General Data Protection Regulation (GDPR) 2016/679. Any personal data processed in connection with this survey will be treated confidentially and only used by the ESC for the purposes of market research and not for promotion. Survey results will be kept for a maximum of 48 months for analysis and quality control purposes. We take all reasonable care to prevent any unauthorised access to your personal data. We respect your privacy and your right to access, modify, or remove your personal data. At any time, you can ask to know what personal data is being held. If you have any questions about data protection or require further information, please contact our data protection officer (DPO) at dpo@escardio.org.
You have the right to end your participation in this survey at any time.

1.Please confirm that you have read the above and agree to participate in this survey

Yes

No

Organisation

2.In which country/state do you work?

3.Kind of hospital (tick all that apply):

Teaching/Academic

Non-Teaching/peripheral

Other (please specify)

4.Please indicate

Name of the Hospital

City

6.How many Cardiac ICU beds are there in your unit?

5-10

10-25

>25

9.Does your hospital/unit perform periodic training refreshers/educational programmes on tMCS management?

Yes

No

11.Where are the cardiogenic shock patients on temporary mechanical circulatory support transferred after the implantation at your hospital? (tick all that apply)

General/Mixed ICU

Cardiac ICU/coronary care unit

Cardiac Surgery ICU

V-A ECMO

General/Mixed ICU

Cardiac ICU/coronary care unit

Cardiac Surgery ICU

mAFP (micro axial flow pump)

General/Mixed ICU

Cardiac ICU/coronary care unit

Cardiac Surgery ICU

Clinical evaluation and ICU monitoring

Individual tMCS-devices

Intra-aortic balloon pump

14.Do you use IABP at your institution?

Yes

No

15.Where is it routinely implanted?

Bedside

Cath lab

Both

16.Which are the main indications for IABP placement? (tick all that apply)

17.In patients supported with IABP alone (i.e., not for ACS treatment), which of the following medications do you administer to prevent thrombotic complications, assuming no contraindications?

V-A ECMO

18.Do you use V-A ECMO at your institution?

Yes

No

19.Do you routinely insert distal or antegrade limb perfusion catheter at the time of ECMO cannulation?

Always

Only in case of evidence of hypoperfusion

22.Do you have a sweep flow and FiO2 titration protocol?

Yes

No

23.Which is the tidal volume strategy you usually apply in V-A ECMO patient?

<4ml/Kg

4-6 ml/Kg

6-8 ml/kg

>8ml/Kg

24.How do you manage Harlequin syndrome (North-South syndrome)? Tick all that apply

ProtekDuo or single-lumen cannula in right internal jugular vein on top of V-A

Titrate ECMO flows

Left ventricular axial flow devices (e.g. impella)

Hybrid configuration (V-AV or VV-A ECMO)

Mechanical ventilation adjustment

Referral to a more experienced centre

25.Once on tMCS, do you try to completely wash out from

Yes

No

Inotropes

Yes

No

Vasopressors

Yes

No

Axial Flow device

26.Do you use mAFP (micro axial flow pump) at your institution?

Yes

No

27.Which is/are the most common reason(s) to escalate from Impella CP to Impella 5.5 (except for transplant)?

Inefficient support/unloading

Foreseen time on tMCS≥ 3-5 days

Haemolysis

LVAD upgrade

29.Do you systematically use in the purge solution for any case ?

Heparin

Bicarbonate

Nothing

31.Do you have a P level titration protocol?

Yes

No

Unloading

33.How often do you place a device for mechanical unloading at the time of ECMO cannulation?

Weaning

37.For femoral V-A ECMO support, what type of decannulation approach do you prefer?

Percutaneous closure

Surgical closure

38.Which weaning liberation protocol do you adopt in V-A ECMO supported patients's (tick all that apply)?

Step wise reduction of flow till 1.5/1 L/min

Pump controlled retrograde flow (PCRTO)

Temporary clamping of the cannulas

39.Which weaning protocol do you adopt in axial flow device supported patients?

Stepwise reduction of P level of 33% for each step

Stepwise reduction of P level of 50% for each step

Reduction from the highest P level to P 2 without steps

Don’t have a specific weaning protocol

42.Do you regularly (> 51%) start inotropes/vasopressors prior to initiating the liberation process if a patient is not already ongoing?

Yes

No

Outcome and follow up

46.Would you be willing to participate at centre or network level to a prospective data collection for a specific time frame (inception study)?

Yes

No

If yes, please send an email to escacute@escardio.org and indicate your contact details and your role in the centre where you work