Stub Dion, Chan William, Ball Jocasta, Burell Aidan, Ihle Josh, Theng Steven, Tsintzos Stelios, Kaye David M, Seage Tahlia, Mudge Mia
Abiomed, Singapore.
Abiomed, Aachen, Germany.
Shock. 2025 Apr 1;63(4):512-519. doi: 10.1097/SHK.0000000000002540. Epub 2025 Feb 7.
Background: Veno-arterial extracorporeal membrane oxygenation (VA ECMO) and Impella, a transluminal microaxial ventricular assist device, are well-established in the management of cardiogenic shock. No randomized controlled trials (RCTs) directly compare Impella versus VA ECMO to inform their safety and efficacy in cardiogenic shock. Purpose: This study aims to conduct a systematic review and meta-analysis of propensity score-matched/adjusted studies to compare the clinical outcomes of Impella versus VA ECMO in cardiogenic shock patients. Methods: A systematic review was undertaken to identify comparative studies of Impella and VA ECMO in cardiogenic shock, which in the absence of RCTs, was limited to observational trials with propensity-matched or adjusted outcomes to account for important confounding factors between populations. In-hospital/30-day survival and bleeding events requiring transfusion were meta-analyzed using the random effects method. Results: Five propensity score-matched/adjusted studies comparing short-term survival following treatment with Impella versus VA ECMO were included. A statistically significant difference in in-hospital/30-day mortality was detected between patients treated with Impella (39.6%) versus VA ECMO (53.8%) (odds ratio [95% confidence interval]: 0.57 [0.44, 0.74]; P < 0.0001). Impella was associated with significantly fewer bleeding events requiring transfusion compared with VA ECMO (19.9% vs. 28.8%, respectively) (OR [95% confidence interval]: 0.61 [0.46, 0.80]; P = 0.0004). Conclusion: In the absence of RCTs, this meta-analysis of propensity matched/adjusted observational trials represents the highest level of evidence available to date. Impella was associated with improved short-term survival and decreased bleeding events compared to VA ECMO in patients with cardiogenic shock.
静脉 - 动脉体外膜肺氧合（VA ECMO）和经腔微轴心室辅助装置Impella在心源性休克的治疗中已得到广泛应用。尚无随机对照试验（RCT）直接比较Impella与VA ECMO在心源性休克中的安全性和有效性。目的：本研究旨在对倾向评分匹配/调整的研究进行系统评价和荟萃分析，以比较Impella与VA ECMO在心源性休克患者中的临床结局。方法：进行系统评价以确定Impella与VA ECMO在心源性休克中的比较研究，由于缺乏RCT，该研究仅限于倾向匹配或调整结局的观察性试验，以考虑不同人群之间的重要混杂因素。采用随机效应方法对住院/30天生存率和需要输血的出血事件进行荟萃分析。结果：纳入了五项比较Impella与VA ECMO治疗后短期生存率的倾向评分匹配/调整研究。接受Impella治疗的患者（39.6%）与接受VA ECMO治疗的患者（53.8%）之间在住院/30天死亡率上存在统计学显著差异（比值比[95%置信区间]：0.57 [0.44, 0.74]；P < 0.0001）。与VA ECMO相比，Impella需要输血的出血事件明显更少（分别为19.9%和28.8%）（OR [95%置信区间]：0.61 [0.46, 0.80]；P = 0.0004）。结论：在缺乏RCT的情况下，这项对倾向匹配/调整的观察性试验的荟萃分析代表了迄今为止可用的最高证据水平。与VA ECMO相比，Impella在心源性休克患者中与短期生存率提高和出血事件减少相关。
