<h2 id="hl0000499">Abstract</h2> <h2 id="hl0000501">Background</h2> <p id="hl0000502">The effect of standardizing an insertion and removal protocol for pVAD devices has not been previously described.</p> <h2 id="hl0000504">Objectives</h2> <p id="hl0000505">We sought to evaluate clinical outcomes in patients who underwent pVAD insertion pre- and post-protocol standardization.</p> <h2 id="hl0000507">Methods</h2> <p id="hl0000508">All patients who underwent pVAD insertion that remained in place at index procedure completion between January 2017 and September 2023 at a single academic center for both high-risk PCI and cardiogenic shock indications were included in the study. The primary outcome was the incidence of limb ischemia and major bleeding before and after the protocol initiation. Secondary outcomes included in-hospital and 30-day MACCE rate (death, myocardial infarction, stroke, emergent CABG), and how often the operators followed the protocol.</p> <h2 id="hl0000510">Results</h2> <p id="hl0000511">A total of 89 patients had pVAD left in place (29 pre-protocol initiation and 60 post-protocol initiation). There was a significant decrease in incidence of limb ischemia post-protocol initiation compared to pre (17.2 % vs 1.7 %,<span> </span><i>p</i><span> </span>= 0.01) but no difference in bleeding incidence (13.8 % vs 20.0 %,<span> </span><i>p</i><span> </span>= 0.47). Adherence increased in all components of the protocol except for right heart catheterization.</p> <h2 id="hl0000515">Conclusion</h2> <p id="hl0000516">Standardization of an insertion and removal protocol for pVAD devices led to a statistically significant decrease in limb ischemia in a high-risk patient population.</p>