General Critical Care

Mechanical circulatory support for cardiogenic shock: a network meta-analysis of randomized controlled trials and propensity score-matched studies | Intensive Care Medicine (springer.com)

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In this network meta-analysis, they evaluated the effectiveness of various mechanical circulatory support (MCS) devices in patients with refractory cardiogenic shock, a condition associated with high mortality. The comprehensive search across MEDLINE, Embase, and Scopus databases up to August 27, 2023, included 38 studies with 48,749 patients. The primary outcome was mortality, assessed either at 30 days or during hospitalization.

The analysis revealed that only the combination of extracorporeal membrane oxygenation with an intra-aortic balloon pump (ECMO-IABP) was associated with a significant reduction in mortality compared to no MCS. Other MCS configurations (such as ECMO, IABP, microaxial ventricular assist device (mVAD), ECMO-mVAD, centrifugal VAD, or mVAD-IABP) did not show a statistically significant mortality reduction. These findings, derived from a mixture of randomized controlled trials and propensity score-matched studies, highlight ECMO-IABP as potentially beneficial in reducing mortality in cardiogenic shock, albeit with considerations for the heterogeneity and limited certainty of the evidence.