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

BMC Cardiovascular Disorders

Bailu Wang¹  Chuanxin Zhang²  Qun Zhang²  Shukun Sun²  Han Liu²  Shujian Wei²  Yu Han² 

[1] Clinical Trial Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, China;Department of Emergency and Chest Pain Center, Qilu Hospital, Cheeloo College of Medicine, Shandong University, NO. 107, 250012, Jinan, Shandong, China;Clinical Research Center for Emergency and Critical Care Medicine of Shandong Province, Institute of Emergency and Critical Care Medicine of Shandong University, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, China;Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Key Laboratory of Cardiopulmonary-Cerebral Resuscitation Research of Shandong Province, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, China;The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese Ministry of Health and Chinese Academy of Medical Sciences; The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Qilu Hospital, Cheeloo College of Medicine, Shandong University, 250012, Jinan, Shandong, China;

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

DOI  :  10.1186/s12872-022-02493-0

来源: Springer

【 摘 要 】

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

【 授权许可】

CC BY