Resource utilization associated with extracorporeal membrane oxygenation vs. microaxial flow pump for infarct-related cardiogenic shock

AIMS: Microaxial flow pump and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are increasingly used in infarct-related cardiogenic shock. This study provides a comparative overview of real-world resource utilization associated with these devices (PROSPERO: CRD42024505174).

METHODS AND RESULTS: EMBASE, MEDLINE, and Cochrane Library were sought from inception to 13 November 2024 for studies reporting at least one primary outcome, including intensive care unit (ICU) length of stay (LOS), hospital LOS, in-hospital costs, and discharge destination. In-hospital mortality was included as secondary outcome. This study was guided by the PRISMA-2020 guideline. Study selection and data extraction were independently performed by two researchers. Risk-of-bias assessments were done using the Newcastle-Ottawa-Scale. Data were pooled using random-effect models. In total, 12 retrospective cohorts were identified encompassing 92 262 microaxial flow pump- and 16 474 VA-ECMO patients data. The meta-analysis of hospital LOS and in-hospital costs revealed favourable results for the microaxial flow pump, with mean differences (MD) of -5.3 days (95% CI: -6.6, -4.1) and -$113 983 (95% CI: -$143 153, -$84 812), respectively. Microaxial flow pump survivors were also 45% more likely to be discharged home (95% CI: 1.28-1.64). Intensive care unit-length of stay was reported by one study, reporting a 10 days MD in favour of the microaxial flow pump. The averaged in-hospital mortality rates were 44% and 57% for the microaxial flow pump and VA-ECMO, respectively. An inherent limitation of observational studies is confounding by indication.

CONCLUSION: Microaxial flow pump was associated with lower resource utilization compared with VA-ECMO. Resource utilization should be incorporated in prospective RCTs and taken into account when considering these devices.