TY - JOUR
T1 - Temporary mechanical circulatory support after return of spontaneous circulation following cardiac arrest
T2 - a systematic review and meta-analysis
AU - Scquizzato, Tommaso
AU - Grunau, Brian
AU - Fernando, Shannon
AU - Chia, Yew Woon
AU - Leong, Carrie
AU - D'Arrigo, Sonia
AU - Møller, Jacob E
AU - Brunner, Stefan
AU - Henriques, Jose Ps
AU - Scandroglio, Anna Mara
AU - Berg, Katherine
AU - Drennan, Ian R
AU - Skrifvars, Markus B
AU - International Liaison Committee on Resuscitation Advanced Life Support Task Force
N1 - Copyright © 2025 Elsevier B.V. All rights reserved.
PY - 2025/12
Y1 - 2025/12
N2 - BACKGROUND: Shock with cardiogenic involvement is common after return of spontaneous circulation (ROSC) following cardiac arrest. Temporary mechanical circulatory support (MCS) is increasingly used in acute myocardial infarction-related cardiogenic shock (AMI-CS), but its efficacy in post-cardiac arrest patients remains uncertain.METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing MCS (extracorporeal membrane oxygenation, intra-aortic ballon pump, or microaxial flow pump) versus standard care after ROSC. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 19, 2025. The primary outcome was survival at the longest follow-up. Frequentist estimates were complemented by a Bayesian meta-analysis.RESULTS: Fourteen RCTs enrolling 1,842 AMI-CS patients were identified, of whom 762 had achieved ROSC after in- or out-of-hospital cardiac arrest. In these patients, MCS did not improve survival at the longest follow-up (46% with MCS vs 41% with standard care; RR 1.10 [95% CI, 0.94-1.29]; p=0.23; I2=0.0%). Bayesian analysis (RR 1.13 [95% CrI, 0.90-1.44]) showed an 88% posterior probability of any survival benefit (absolute risk difference >0%) and a 56% probability of a clinically relevant benefit (>5%). In patients with no or cardiac arrest duration < 10 minutes, MCS improved survival (56% vs 45%; RR 1.25 [95% CI, 1.06-1.47]; p=0.007). MCS was associated with increased device-related complications.CONCLUSIONS: Routine use of temporary MCS does not improve survival in unselected cardiac arrest patients with AMI-CS and increased complication rates. Future research should target more carefully selected patients with lower risk of hypoxic-ischemic brain injury.REVIEW REGISTRATION: PROSPERO CRD42024566810.
AB - BACKGROUND: Shock with cardiogenic involvement is common after return of spontaneous circulation (ROSC) following cardiac arrest. Temporary mechanical circulatory support (MCS) is increasingly used in acute myocardial infarction-related cardiogenic shock (AMI-CS), but its efficacy in post-cardiac arrest patients remains uncertain.METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing MCS (extracorporeal membrane oxygenation, intra-aortic ballon pump, or microaxial flow pump) versus standard care after ROSC. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 19, 2025. The primary outcome was survival at the longest follow-up. Frequentist estimates were complemented by a Bayesian meta-analysis.RESULTS: Fourteen RCTs enrolling 1,842 AMI-CS patients were identified, of whom 762 had achieved ROSC after in- or out-of-hospital cardiac arrest. In these patients, MCS did not improve survival at the longest follow-up (46% with MCS vs 41% with standard care; RR 1.10 [95% CI, 0.94-1.29]; p=0.23; I2=0.0%). Bayesian analysis (RR 1.13 [95% CrI, 0.90-1.44]) showed an 88% posterior probability of any survival benefit (absolute risk difference >0%) and a 56% probability of a clinically relevant benefit (>5%). In patients with no or cardiac arrest duration < 10 minutes, MCS improved survival (56% vs 45%; RR 1.25 [95% CI, 1.06-1.47]; p=0.007). MCS was associated with increased device-related complications.CONCLUSIONS: Routine use of temporary MCS does not improve survival in unselected cardiac arrest patients with AMI-CS and increased complication rates. Future research should target more carefully selected patients with lower risk of hypoxic-ischemic brain injury.REVIEW REGISTRATION: PROSPERO CRD42024566810.
KW - Cardiogenic shock
KW - Cardiopulmonary resuscitation
KW - Extracorporeal membrane oxygenation
KW - Intra-aortic ballon pump
KW - Left ventricular assist device
KW - Mechanical circulatory support
KW - Out-of-hospital cardiac arrest
KW - Post-resuscitation care
KW - Humans
KW - Myocardial Infarction/complications
KW - Return of Spontaneous Circulation
KW - Cardiopulmonary Resuscitation/methods
KW - Shock, Cardiogenic/therapy
KW - Out-of-Hospital Cardiac Arrest/therapy
KW - Heart Arrest/therapy
KW - Randomized Controlled Trials as Topic
KW - Extracorporeal Membrane Oxygenation/methods
KW - Bayes Theorem
UR - https://www.scopus.com/pages/publications/105023056138
U2 - 10.1016/j.resuscitation.2025.110893
DO - 10.1016/j.resuscitation.2025.110893
M3 - Review
C2 - 41232590
SN - 0300-9572
VL - 217
JO - Resuscitation
JF - Resuscitation
M1 - 110893
ER -