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Cardiogenic shock requires assist devices in order to increase systemic blood supply including coronaries flow improving morbidity and mortality. We aimed to investigate the short-tem of clinical outcomes (morbidity and mortality) of these devices; IABP and pLVAD (Impella and Tandem) for patients with cardiogenic shock.
We searched PubMed, EMBASE, and Cochrane databases up to June 2017. Primary outcomes included 30 days mortality and CVA. Secondary outcomes studied were leg ischemia, major bleeding, cardiac output and cardiac index. We used fixed or random effect analysis using the Cochrane Handbook of Systematic Reviews and RevMan 5.2 for statistical analysis.
We included a total of four RCT’s in this analysis. The pooled data provided a total of 148 patients, 71 receiving IABP and 77 receiving pLVAD. Primary outcomes analysis showed no significant difference in 30 day mortality between groups as well as CVA events. Bleeding complications were significantly less in the IABP group compared to the pLVAD (21% vs. 55%, p < 0.01). There were less significant less leg ischemia events in the IABP group (4% vs. 23%, p=0.02). Cardiac output and cardiac index were significantly better in the pLVAD group compared to IABP group (p<0.05).
Our analysis suggested no difference in mortality or neurological events between the two groups. pLVAD can lead to better CO and CI compared to IABP but at costs of increased bleeding and leg ischemia events. Further trials evaluating long term of these clinical events should be pursued.
CORONARY: Hemodynamic Support and Cardiogenic Shock