Canadian Patterns of Temporary Mechanical Circulatory Support: A Report by the C3 Cardiogenic Shock Working Group

Background Contemporary national data on temporary mechanical circulatory support (tMCS) practice patterns within Canada's publicly funded healthcare system are limited. Methods In 2025, a cross-sectional survey was distributed to catheterization laboratory and cardiac intensive care unit directors at all 50 Canadian hospitals with cardiac catheterization capabilities. Data were collected on tMCS access, utilization, funding, protocols, and perceived barriers. Results Forty-seven institutions (94%) responded. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was available at 33 sites (70%), percutaneous microaxial flow pumps (pMFP) at 25 sites (53%), 23 (49%) had both, and 12 (26%) had no advanced tMCS; 88% of sites with pMFP were academic, while 94% of sites with VA-ECMO were academic. Sites use pMFP for cardiogenic shock (CS) (92%), high-risk percutaneous coronary intervention (96%), and left ventricular unloading during VA-ECMO (56%). VA-ECMO is used for CS (97%), post-cardiotomy shock (90%) and extracorporeal cardiopulmonary resuscitation (55%). Funding is predominantly hospital based (91%), with variable provincial support. Major barriers to tMCS access include lack of funding (92%) and limited interprofessional support (92%). Among tMCS capable sites, protocols are common for eligibility (83%) and daily management (71%), but less frequent for insertion (43%) and weaning or explant (43%). Conclusions Access to tMCS in Canada is heterogeneous and concentrated in academic centers, with funding and limited interprofessional support representing the principal barriers to broader adoption. Strengthening funding frameworks, expanding regional systems of care and expertise, and implementing protocolized management may improve equitable access to high quality tMCS care across Canada.