Figure 3

Simplified flow diagram of initiation of mechanical circulatory support. Patients requiring full mechanical circulatory support should be referred to experienced, high-volume centers. *See Table 4 for contraindications to mechanical circulatory support. ^†Inotrope score = doses of dopamine + dobutamine μg/kg per min + [(epinephrine + norepinephrine + isoproterenol μg/kg per min) × 100] + [milrinone μg/kg per min × 15]. AMI, acute myocardial infarction; APO, acute pulmonary edema; AR, aortic regurgitation; ECMO, extracorporeal membrane oxygenation; IABP, intra-aortic balloon pump; IPPV, invasive positive pressure ventilation; LVAD, left ventricular assist device; MCS, mechanical circulatory support.