<h3>Introduction</h3> As time on temporary mechanical circulatory support (TMCS) increases, so does risk of device-related complications. Decisions to wean TMCS are largely based on echocardiographic (echo) and pulmonary artery catheter data. We describe the use of pulse contour analysis (PCA) for real-time decision making during TMCS. <h3>Case Report</h3> A 58-year-old male with CAD and recent anterior STEMI with PCI to LAD presented with cardiogenic shock. LV apical thrombus was noted in echo. He developed pulmonary edema and respiratory failure requiring mechanical ventilation. Invasive hemodynamics were notable for: RA 25mmHg, PCWP 45mmHg, CO 3.45 L/min, CI 1.5 L/min/m2. An IABP was placed but his condition rapidly deteriorated despite escalating inotropes, culminating in VF arrest. Left atrial to femoral artery support with Tandem Heart (TH) was started. On day 10, he developed hemoptysis and rectal bleeding. A decision was made to wean TMCS to stop anticoagulation given ongoing bleeding. Initial TH flow was 3.5-3.7 L/min at a speed of 6900 RPM (Fig 1A). Systemic flow by PCA was 2.9-3L which correlated with CO by thermodilution at ∼3 L/min (6.85L/min - 3.5 L/min)(Fig 1B and 1C). At a TH flow of 2 L/min, CO estimate by PCA was available for bedside analysis and remained low at 4.0 l/min (CI 1.8/min/m2) despite no change in cardiac chamber size or filling pressures. Echo data and filling pressures did not reflect his poor native blood flow as TMCS was weaned and further weaning could have caused progressive shock. Based on the persistently low CO estimates noted by PCA, a decision was made to continue MCS until he underwent durable LVAD implant. <h3>Summary</h3> PCA estimates SV based on the contour of the arterial pressure tracing, and when coupled with HR approximates systemic flow. PCA is most accurate in the absence of arrhythmia or respiratory variability. Data is continuously updated in real time compared to conventional measures of CO. To our knowledge this is the first report of the use of PCA to aid real time decision making during TMCS.