Alex Rosenberg

Early, structured ambulatory follow-up after hospitalization for acute cardiac events remains a key unmet need in cardiovascular care. This clinical consensus statement of the Association for Acute CardioVascular Care of the ESC provides pragmatic, condition-specific guidance on post discharge management and (early) ambulatory re-evaluation for patients admitted to an acute cardiac care unit. It complements existing disease-oriented guidelines by focusing on the vulnerable transition from hospital to home rather than on acute in-hospital treatment. The document first defines key concepts and outlines general principles regarding timing, content, and organization of the first post-discharge contacts, including risk stratification, medication reconciliation, symptom assessment, evaluation of psychosocial status and comorbidities, patient and family education, and integration of cardiac rehabilitation. In practice, the consensus statement discusses the patient’s path after discharge: how should the follow-up team look like, when should the first and subsequent visits be planned, what should be done at each contact, and how can multidisciplinary teams and hybrid (in-person plus remote) models be implemented according to local resources. Supplementary material highlights major evidence gaps, including the optimal timing and intensity of follow-up, the composition of ambulatory teams, the role of telemonitoring and digital health, and the needs of vulnerable populations. Overall, this consensus aims to support clinicians in designing structured, individualized, and scalable ambulatory pathways after acute cardiac care.

Extracorporeal cardiopulmonary resuscitation for refractory out‐of‐hospital cardiac arrest is increasingly used, with survival rates up to ≈30% reported in select highly organized systems, although outcomes vary widely across programs. However, outcomes are driven largely by system performance rather than the procedure itself. To date, most literature has focused on efficacy, patient selection, and cannulation techniques, with limited emphasis on system‐level design. This narrative review synthesizes the key components required to implement an effective extracorporeal cardiopulmonary resuscitation–enabled cardiac arrest system from optimizing the existing emergency medical services, understanding the expected number and distribution of potential patients undergoing extracorporeal cardiopulmonary resuscitation, using geographic information systems to optimize system design to the value of integrated structured identification pathways, streamlined intra‐arrest transport strategies, coordinated postresuscitation care within specialized cardiac arrest centers, and cost‐effectiveness considerations.

Background: The global adoption of extracorporeal cardiopulmonary resuscitation (ECPR) for cardiac arrest is accelerating, reflecting its potential to improve outcomes in select patient populations. Although research has increasingly focused on patient selection criteria, there remains a critical lack of evidence to guide best practices in post‐ECPR resuscitation management. This study aimed to identify key knowledge gaps and develop consensus‐based recommendations to inform clinical decision‐making in the post‐ECPR setting. Methods: An international, multidisciplinary steering committee comprising 11 ECPR experts and 1 survivor conducted a targeted literature review to identify key domains and gaps in post‐ECPR care. Experts were recruited based on field impact and snowball sampling. A modified Delphi process was used, comprising 3 survey rounds. Consensus was defined a priori as ≥70% agreement or disagreement on Likert‐scale statements. Results: A total of 53 experts were recruited, representing diverse health care professions, gender, and levels of clinical experience. Of these, 52 (98%) completed all 3 rounds of the Delphi process. Consensus was reached on 126 individual statements, which were synthesized into 42 summary position statements. These recommendations span key domains of post‐ECPR care, including system‐level considerations, hemodynamic targets and management strategies, ventilation and oxygenation protocols, anticoagulation practices, temperature regulation, complication mitigation, weaning approaches, and neuroprognostication. Conclusions: This modified Delphi study, informed by a diverse international panel, resulted in 42 consensus‐based position statements addressing key aspects of post‐ECPR care. In the absence of robust empirical evidence, these expert‐derived recommendations offer a valuable framework to support clinical decision‐making and the development of standardized post‐ECPR resuscitation protocols. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT06552312.

The use of left-sided Impella microaxial flow pumps has expanded rapidly for the management of cardiogenic shock, left ventricular unloading and as a bridge to heart transplantation. However, standard life support and resuscitation algorithms are not directly applicable to patients receiving this therapy due to fundamental alterations in circulatory physiology. To address this gap, eleven UK Impella centres and eight national professional societies collaborated to develop a unified national consensus statement on the emergency management of patients with left-sided Impella support. Using a systematic review of the literature and a modified Delphi process guided by the European Society of Cardiology framework for grading recommendations, expert representatives achieved agreement on key priorities and structured actions to be undertaken in the first few minutes of resuscitation. The consensus outlines early recognition of circulatory inadequacy (mean arterial pressure <30 mm Hg or end-tidal CO₂ <2 kPa), prompt activation of multidisciplinary responders, reduction of Impella power to P2 before initiating cardiopulmonary resuscitation and structured division of patient-focused and device-focused teams. Device-specific troubleshooting algorithms are presented for suction, malposition, purge-system failure and mechanical malfunction. This multisociety consensus represents the first national standard for emergency management and resuscitation of patients supported by a left-sided Impella device and is intended to inform structured clinical training and improve patient outcomes through rapid, coordinated and physiologically tailored interventions.