Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies

Christopher Jer Wei Low^#¹, Ryan Ruiyang Ling^#¹, Michele Petrova Xin Ling Lau¹, Nigel Sheng Hui Liu¹, Melissa Tan², Chuen Seng Tan^{1

3}, Shir Lynn Lim^{1

4

5}, Bram Rochwerg^{6

7}, Alain Combes^{8

9}, Daniel Brodie¹⁰, Kiran Shekar^{11

12

13

14}, Susanna Price^{15

16}, Graeme MacLaren^{1

2}, Kollengode Ramanathan^{17

18}

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
² Cardiothoracic Intensive Care Unit, National University Hospital, National University Health System, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
³ Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
⁴ Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore.
⁵ Duke-NUS Medical School, Pre-Hospital and Emergency Research Center, Singapore, Singapore.
⁶ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁸ Service de Médecine Intensive-RéanimationInstitut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.
⁹ UMRS 116, Institute of Cardio Metabolism and Nutrition, Sorbonne Universite INSERM, Paris, France.
¹⁰ Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
¹¹ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.
¹² Queensland University of Technology, Gold Coast, QLD, Australia.
¹³ University of Queensland, Gold Coast, QLD, Australia.
¹⁴ Bond University, Gold Coast, QLD, Australia.
¹⁵ Royal Brompton and Harefield Hospitals, London, UK.
¹⁶ National Heart and Lung Institute, Imperial College, London, UK.
¹⁷ Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore. surrkr@nus.edu.sg.
¹⁸ Cardiothoracic Intensive Care Unit, National University Hospital, National University Health System, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore. surrkr@nus.edu.sg.

^# Contributed equally.

PMID: 38206381
DOI: 10.1007/s00134-023-07278-3

Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies

Christopher Jer Wei Low et al. Intensive Care Med. 2024 Feb.

. 2024 Feb;50(2):209-221.

doi: 10.1007/s00134-023-07278-3. Epub 2024 Jan 11.

Authors

Affiliations

¹ Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore.
² Cardiothoracic Intensive Care Unit, National University Hospital, National University Health System, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore.
³ Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore.
⁴ Department of Cardiology, National University Heart Centre, National University Health System, Singapore, Singapore.
⁵ Duke-NUS Medical School, Pre-Hospital and Emergency Research Center, Singapore, Singapore.
⁶ Division of Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada.
⁷ Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada.
⁸ Service de Médecine Intensive-RéanimationInstitut de Cardiologie, Assistance Publique-Hôpitaux de Paris, Hôpital Pitié-Salpêtrière, Paris, France.
⁹ UMRS 116, Institute of Cardio Metabolism and Nutrition, Sorbonne Universite INSERM, Paris, France.
¹⁰ Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD, USA.
¹¹ Adult Intensive Care Services, The Prince Charles Hospital, Brisbane, QLD, Australia.
¹² Queensland University of Technology, Gold Coast, QLD, Australia.
¹³ University of Queensland, Gold Coast, QLD, Australia.
¹⁴ Bond University, Gold Coast, QLD, Australia.
¹⁵ Royal Brompton and Harefield Hospitals, London, UK.
¹⁶ National Heart and Lung Institute, Imperial College, London, UK.
¹⁷ Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore, Singapore. surrkr@nus.edu.sg.
¹⁸ Cardiothoracic Intensive Care Unit, National University Hospital, National University Health System, Level 9, 1E Kent Ridge Road, Singapore, 119228, Singapore. surrkr@nus.edu.sg.

^# Contributed equally.

PMID: 38206381
DOI: 10.1007/s00134-023-07278-3

Abstract

Purpose: Cardiogenic shock is associated with high mortality. In refractory shock, it is unclear if mechanical circulatory support (MCS) devices improve survival. We conducted a network meta-analysis to determine which MCS devices confers greatest benefit.

Methods: We searched MEDLINE, Embase, and Scopus databases through 27 August 2023 for relevant randomized controlled trials (RCTs) and propensity score-matched studies (PSMs). We conducted frequentist network meta-analysis, investigating mortality (either 30 days or in-hospital) as the primary outcome. We assessed risk of bias (Cochrane risk of bias 2.0 tool/Newcastle-Ottawa Scale) and as sensitivity analysis reconstructed survival data from published survival curves for a one-stage unadjusted individual patient data (IPD) meta-analysis using a stratified Cox model.

Results: We included 38 studies (48,749 patients), mostly reporting on patients with Society for Cardiovascular Angiography and Intervention shock stages C-E cardiogenic shock. Compared with no MCS, extracorporeal membrane oxygenation with intra-aortic balloon pump (ECMO-IABP; network odds ratio [OR]: 0.54, 95% confidence interval (CI): 0.33-0.86, moderate certainty) was associated with lower mortality. There were no differences in mortality between ECMO, IABP, microaxial ventricular assist device (mVAD), ECMO-mVAD, centrifugal VAD, or mVAD-IABP and no MCS (all very low certainty). Our one-stage IPD survival meta-analysis based on the stratified Cox model found only ECMO-IABP was associated with lower mortality (hazard ratio, HR, 0.55, 95% CI 0.46-0.66).

Conclusion: In patients with cardiogenic shock, ECMO-IABP may reduce mortality, while other MCS devices did not reduce mortality. However, this must be interpreted within the context of inter-study heterogeneity and limited certainty of evidence.

Keywords: Cardiogenic shock; Mechanical circulatory support; Mortality; Network meta-analysis.

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References

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Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies

Affiliations

Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies

Authors

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Abstract

References

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