Mechanical circulatory support (MCS) devices have become widely accepted therapeutic options for cardiogenic shock and medically refractory advanced heart failure. However, both temporary and durable MCS devices are prone to a wide range of complications, most notably bleeding, thrombosis, neurological events, hemolysis, infection, and right heart failure. Standardized protocols in the areas of blood pressure control, anticoagulation, hemodynamic optimization, and driveline care have the potential of reducing practice pattern variation, preventing complications, and improving patient outcomes.