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

• Published in: BMC cardiovascular disorders 2022-02, Vol.22 (1), p.48-48, Article 48
• Main Authors: Zhang, Qun, Han, Yu, Sun, Shukun, Zhang, Chuanxin, Liu, Han, Wang, Bailu, Wei, Shujian
• Format: Article
• Language: English
• Subjects: Aorta; Balloon treatment; Bias; Cardiogenic shock; Cardiovascular instruments, Implanted; Care and treatment; Clinical trials; Extracorporeal membrane oxygenation; Extracorporeal Membrane Oxygenation - adverse effects; Extracorporeal Membrane Oxygenation - mortality; Heart attacks; Heart, Artificial; Heart-Assist Devices; Hospital Mortality; Humans; Impella; Intra-aortic balloon pump; Intra-Aortic Balloon Pumping - adverse effects; Intra-Aortic Balloon Pumping - mortality; Mechanical circulatory support; Medical research; Meta-analysis; Mortality; Network Meta-Analysis; Observational Studies as Topic; Oxygenation; Patient outcomes; Quality control; Randomized Controlled Trials as Topic; Risk Assessment; Risk Factors; Shock, Cardiogenic - diagnosis; Shock, Cardiogenic - mortality; Shock, Cardiogenic - physiopathology; Shock, Cardiogenic - therapy; Software; Tandem heart; Time Factors; Treatment Outcome; Venoarterial extracorporeal membrane oxygenation
• ISSN: 1471-2261; 1471-2261
• DOI: 10.1186/s12872-022-02493-0

Mechanical circulatory support (MCS) devices are widely used for cardiogenic shock (CS). This network meta-analysis aims to evaluate which MCS strategy offers advantages. 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. 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. IABP more effectively reduce the incidence of 30-day mortality compared with VA-ECMO and Impella for the treatment of CS.