**6. Conclusion**

CS is a serious and life threating problem with high mortality rates. In case of acute ventricular failure, the main goal is to quickly implement measures to allow for ventricular recovery, by offloading volume and pressure, while maintaining adequate end-organ perfusion. When conventional treatment options fail, acute mechanical circulatory support is indicated. The ProtekDuo in RVAD configuration has the particular advantage over other single-site cannula-based temporary percutaneous RVADs because it is placed in the upper body versus the groin, thus allowing the patient to freely use the lower extremities in case of mobilization. Further, the ProtekDuo is compatible with a variety of blood pumps and may be used with a membrane oxygenator (ECMO) in case of concomitant respiratory failure, which is not an available option with other single-site, temporary percutaneous RVADs. When used in ECMO configuration, the ProtekDuo® may be used for V-P, V-VP, and VP-A ECMO as well as in PROpella configuration. Each option has specific benefits for patients requiring individual support for respiratory, right heart, left heart or biventricular failure. In V-P position, a mean blood flow of 4.5 LPM may be achieved but can be increased to 7 LPM in patients with V-VP configuration for ARDS. With increasing blood flow, increasing oxygenation may be achieved. Most literature on the ProtekDuo® in ARDS exists for COVID-19, where it has been shown to improve outcomes, reduce AKI and consecutively reduce the need for CRRT. The use of the ProtekDuo® for other ARDS etiologies has not yet been described. Cardiocirculatory support may be provided in PROpella or VP-A configuration. All options have been used and shown to be feasible. With a limited number of cases, safety cannot be guaranteed but may be likely.
