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

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

Qun Zhang  1   2   3   4 , Yu Han  1   2   3   4 , Shukun Sun  1   2   3   4 , Chuanxin Zhang  1   2   3   4 , Han Liu  1   2   3   4 , Bailu Wang  5 , Shujian Wei  6   7   8   9
Affiliations

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

Qun Zhang et al. BMC Cardiovasc Disord. .

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.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Fig. 1
Fig. 1
The flow chart of literature retrieval and reasons for article exclusion
Fig. 2
Fig. 2
The forest plots of MCS for in-hospital mortality and 30-day mortality
Fig. 3
Fig. 3
The network diagrams
Fig. 4
Fig. 4
The consistency in direct and indirect comparisons of 30-day mortality
Fig. 5
Fig. 5
The funnel plot of all studies. (A) Venoarterial extracorporeal membrane oxygenation concomitant with Impella; (B) Venoarterial extracorporeal membrane oxygenation; (C) Impella; (D) Intra-aortic balloon pump; (E) Venoarterial extracorporeal membrane oxygenation plus Intra-aortic balloon pump; (F Medical therapy; (G) Tandem Heart; (H) Impella plus Intra-aortic balloon pump; (I) Venoarterial extracorporeal membrane oxygenation or Intra-aortic balloon pump; (J) Tandem Heart or Impella; (K) Surgical Venting
See this image and copyright information in PMC

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