Clinical decision-support aid only — reflects the AtlantiCare Heart & Vascular Institute tMCS protocol. It does not replace bedside clinical judgment. Verify every value independently before acting on it.
1Patient & gas exchange
2Central pressures & perfusion
3Echo — myocardial recovery
Used as reference values for the myocardial-recovery criterion in the de-escalation step.
4Derived hemodynamics
CO estimated by the Fick method: VO2 = 125 mL/min/m² × BSA; CO = VO2 / (Hgb × 1.36 × (SaO2−SvO2) × 10). Reference thresholds are the tMCS pathway's device-sufficiency and de-escalation criteria — confirm with echo and PA-catheter hemodynamics, not a single number.
Reassess this pathway every 6 hours while on temporary MCS. Live hemodynamic snapshot at right pulls from the calculator tab — update those values before working through each step.
Patient on Temporary MCS Support
1
Physiologic decision
Adequate RV support?
No → Add / optimize RV support
Impella LV only → add VA-ECMO. VA-ECMO / pRVAD only → upsize cannula; add RV-failure treatment.
↻ Re-evaluate every 6 hours.
2
Physiologic decision
Adequate LV support?
No → Add / optimize LV support
Impella LV only → increase pump speed, upgrade CP→5.5. VA-ECMO / pRVAD only → add Impella LV.
↻ Re-evaluate every 6 hours.
3
Device / criteria decision
Impella / ECpella support sufficient?
No → Increase MCS flow / upgrade device
LV: MAP ≥60 · lactate <2 · pressors weaned · PAWP <20. RV: PA pulsatility ≥10 · RAP <15 · PAPi ≥1.0.
↻ Reassess every 6–12h — confirm with echo & PA-catheter hemodynamics, not flow rate alone.
4
Device / criteria decision
All de-escalation criteria met?
No → Continue current support
Reassess again in 24 hours.
All four required: underlying condition · end-organ function · hemodynamics (MAP>65, CI>2.2, CPO>0.6W, PAPi>1.0, SvO2>60%) · myocardial recovery (LVEF>25–30%, LVOT-VTI>10cm).
5
Ready for weaning trial
Device-specific weaning
Select the device(s) currently in place to see the weaning approach. Suggested progression with multiple devices: ECMO → pLVAD → pRVAD. Reassess before each device explant.
Decrease flow 0.5 L q2–4h to 1.5–2.0 L/min; increase Impella P-level as required.
Decrease pump speed 1–2 P-levels to minimal support P-2.
Maintain lower P-level; reduce and hold lower pump speed as tolerated.
Standby mode; ratio wean 1:2 or 1:3.