Practice variation in mechanical circulatory support: a cross-sectional questionnaire survey of Japanese interventional cardiologists in the CVIT Kyushu–Okinawa chapter

Mechanical circulatory support (MCS) practice for cardiogenic shock may vary with institutional resources and operator experience, but data from Japanese interventional cardiologists are limited. We conducted an anonymous cross-sectional survey of 720 members of 83 Japanese Association of Cardiovascular Intervention and Therapeutics (CVIT)-certified or affiliated training hospitals in the CVIT Kyushu–Okinawa Chapter (September–October 2025); 536 returned questionnaires (74.4%), and consent was confirmed for 385 (53.5%). The primary analysis included 276 respondents who had performed intra-aortic balloon pump (IABP), veno-arterial extracorporeal membrane oxygenation (VA-ECMO), or Impella CP insertion within 12 months: 163 at Impella-capable and 113 at non-Impella-capable hospitals. Documented MCS and extracorporeal cardiopulmonary resuscitation protocols were more frequently reported by respondents from Impella-capable hospitals (46% vs. 6% and 39% vs. 13%, respectively), as was collaboration with emergency and critical care physicians; no statistically significant difference was detected in perceived need for collaboration. MCS selection varied between groups. At Society for Cardiovascular Angiography and Interventions (SCAI) shock stage C, IABP (44%) and Impella CP (48%) were selected with similar frequency among respondents in Impella-capable hospitals, whereas IABP was selected by 79% in non-Impella-capable hospitals. At stage E, ECPELLA (79%) and VA-ECMO plus IABP (84%) predominated, respectively. Among respondents with device-specific operator experience within 12 months, vascular access and anticoagulation practices varied between groups. Procedural anxiety was lower with higher CVIT qualification; however, 19% of board-certified members reported anxiety about Impella CP insertion and 45% about emergency intubation. These findings identify MCS practice variation across several domains warranting further evaluation.