A national evaluation of perioperative temporary mechanical circulatory support infrastructure and governance in the UK: A survey of adult cardiac surgical centres

IntroductionTemporary mechanical circulatory support (tMCS) for refractory post-cardiac surgery cardiogenic shock (PCCS) is required in 1-2% of cardiac surgical patients. As a prelude to a year-long national service evaluation of tMCS provision in this context, we undertook the first national system-level evaluation of the infrastructure and governance of tMCS for adult cardiac surgery in the UK.MethodsA survey was distributed to the Association for Cardiothoracic Anaesthesia & Critical Care Linkperson Network, including all 35 UK adult cardiac surgical centres. The twenty-question survey inquired about local tMCS availability and use, management of PCCS, reporting frameworks and other local resources.ResultsComplete results were obtained from 26 centres (74%), including two-thirds of the UK's adult heart transplant centres. Centres reported preoperative tMCS use in 1.4%, and up to 4% postoperatively. All centres could provide intra-aortic balloon pump support, which was the most common therapy nationally. Transvalvular microaxial flow pump (39% of centres), venoarterial extracorporeal membrane oxygenation (54%) and ventricular assist devices (19%) were less widely available and less frequently used. Most centres (89%) reported no protocol for the management of PCCS and no local shock team (85%).ConclusionsThe UK currently lacks a co-ordinated perioperative tMCS pathway, and there is marked heterogeneity in the organisation, availability and delivery of perioperative tMCS services across the UK. There is a need to address key system-level gaps, with nationally coordinated pathways, multidisciplinary shock models, standardised reporting structures and network-based referral systems.