The haemodynamic envelope, a novel aviation-inspired safety framework for personalized monitoring in cardiogenic shock

Mortality in severe forms of cardiogenic shock remains above 50%, despite substantial advances in mechanical circulatory support strategies that have enabled clinicians to manage levels of patient complexity once thought unattainable. A key obstacle to effectively implementing and individualizing these sophisticated treatments lies in the continued reliance on outdated safety monitoring strategies that apply uniform cut-off values to a limited set of clinical variables. Such approaches fail to account for the dynamic and patient-specific nature of ‘safe’ haemodynamics. To overcome this, we propose an aviation-inspired safety framework, referred to by ‘the haemodynamic envelope’, designed to continuously and automatically compute patient- and time-specific thresholds across nine interrelated dimensions. This framework defines a dynamic safety window analogous to the systems that transformed flight safety.