Mortality in cardiogenic shock patients receiving mechanical circulatory support: a network meta-analysis

BMC Cardiovasc Disord. 2022 Feb 13;22(1):48. doi: 10.1186/s12872-022-02493-0.

Abstract

Objective: Mechanical circulatory support (MCS) devices are widely used for cardiogenic shock (CS). This network meta-analysis aims to evaluate which MCS strategy offers advantages.

Methods: A systemic search of PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials was performed. Studies included double-blind, randomized controlled, and observational trials, with 30-day follow-ups. Paired independent researchers conducted the screening, data extraction, quality assessment, and consistency and heterogeneity assessment.

Results: We included 39 studies (1 report). No significant difference in 30-day mortality was noted between venoarterial extracorporeal membrane oxygenation (VA-ECMO) and VA-ECMO plus Impella, Impella, and medical therapy. According to the surface under the cumulative ranking curve, the optimal ranking of the interventions was surgical venting plus VA-ECMO, medical therapy, VA-ECMO plus Impella, intra-aortic balloon pump (IABP), Impella, Tandem Heart, VA-ECMO, and Impella plus IABP. Regarding in-hospital mortality and 30-day mortality, the forest plot showed low heterogeneity. The results of the node-splitting approach showed that direct and indirect comparisons had a relatively high consistency.

Conclusions: IABP more effectively reduce the incidence of 30-day mortality compared with VA-ECMO and Impella for the treatment of CS.

Keywords: Cardiogenic shock; Impella; Intra-aortic balloon pump; Mechanical circulatory support; Tandem heart; Venoarterial extracorporeal membrane oxygenation.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Systematic Review

MeSH terms

  • Extracorporeal Membrane Oxygenation / adverse effects
  • Extracorporeal Membrane Oxygenation / mortality*
  • Heart, Artificial*
  • Heart-Assist Devices
  • Hospital Mortality
  • Humans
  • Intra-Aortic Balloon Pumping / adverse effects
  • Intra-Aortic Balloon Pumping / mortality*
  • Network Meta-Analysis
  • Observational Studies as Topic
  • Randomized Controlled Trials as Topic
  • Risk Assessment
  • Risk Factors
  • Shock, Cardiogenic / diagnosis
  • Shock, Cardiogenic / mortality*
  • Shock, Cardiogenic / physiopathology
  • Shock, Cardiogenic / therapy*
  • Time Factors
  • Treatment Outcome