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Benenati S, Toma M, Canale C, et al. Mechanical circulatory support in patients with cardiogenic shock not secondary to cardiotomy: a network meta-analysis. Heart Fail Rev. 2021;doi: 10.1007/s10741-021-10092-y.
Benenati, S., Toma, M., Canale, C., Vergallo, R., Bona, R. D., Ricci, D., Canepa, M., Crimi, G., Santini, F., Ameri, P., & Porto, I. (2021). Mechanical circulatory support in patients with cardiogenic shock not secondary to cardiotomy: a network meta-analysis. Heart failure reviews, . https://doi.org/10.1007/s10741-021-10092-y
Benenati, Stefano, et al. "Mechanical circulatory support in patients with cardiogenic shock not secondary to cardiotomy: a network meta-analysis." Heart failure reviews vol. (2021). doi: https://doi.org/10.1007/s10741-021-10092-y
Benenati S, Toma M, Canale C, Vergallo R, Bona RD, Ricci D, Canepa M, Crimi G, Santini F, Ameri P, Porto I. Mechanical circulatory support in patients with cardiogenic shock not secondary to cardiotomy: a network meta-analysis. Heart Fail Rev. 2021 Mar 06; doi: 10.1007/s10741-021-10092-y. Epub 2021 Mar 06. PMID: 33677732.
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Heart Fail Rev. 2021 Mar 06; doi: 10.1007/s10741-021-10092-y. Epub 2021 Mar 06.

Mechanical circulatory support in patients with cardiogenic shock not secondary to cardiotomy: a network meta-analysis.

Heart failure reviews

Stefano Benenati, Matteo Toma, Claudia Canale, Rocco Vergallo, Roberta Della Bona, Davide Ricci, Marco Canepa, Gabriele Crimi, Francesco Santini, Pietro Ameri, Italo Porto

Affiliations

  1. Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy.
  2. Department of Internal Medicine, University of Genoa, Genova, Italy.
  3. Department of Cardiovascular Sciences, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Roma, Italy.
  4. Cardiac Surgery Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy.
  5. Department of Integrated Surgical and Diagnostic Sciences, University of Genova, Genova, Italy.
  6. Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy. [email protected].
  7. Department of Internal Medicine, University of Genoa, Genova, Italy. [email protected].

PMID: 33677732 DOI: 10.1007/s10741-021-10092-y

Abstract

To compare the efficacy and safety of different mechanical circulatory support (MCS) devices in CS. A total of 24 studies (7 randomized controlled trials-RCTs-and 17 non-RCTs) involving 11,117 patients were entered in a Bayesian network meta-analysis. The primary endpoint was 30-day mortality. Secondary endpoints were stroke and bleeding (requiring transfusion and/or intracranial and/or fatal). Compared with no MCS, extra-corporeal membrane oxygenation (ECMO) reduced 30-day mortality when used both alone (OR 0.37, 95% CrI 0.15-0.90) and together with the micro-axial pump Impella (OR 0.13, 95% CrI 0.02-0.80) or intra-aortic balloon pump (IABP) (OR 0.19, 95% CrI 0.05-0.63), although the relevant articles were affected by significant publication bias. Consistent results were obtained in a sensitivity analysis including only studies of CS due to myocardial infarction. After halving the weight of studies with a non-RCT design, only the benefit of ECMO + IABP on 30-day mortality was maintained (OR 0.22, 95% CI 0.057-0.76). The risk of bleeding was increased by TandemHeart (OR 13, 95% CrI 3.50-59), Impella (OR 5, 95% CrI 1.60-18), and IABP (OR 2.2, 95% CrI 1.10-4.4). No significant differences were found across MCS strategies regarding stroke. Although limited by important quality issues, the studies performed so far indicate that ECMO, especially if combined with Impella or IABP, reduces short-term mortality in CS. MCS increases the hazard of bleeding.

Keywords: Cardiogenic shock; Extracorporeal membrane oxygenation; Impella; Intra-aortic balloon pump; Mechanical circulatory support; TandemHeart

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