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Updated: Dec 19, 2025
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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
Published on: June 12, 2021
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Mechanical assist devices for acute cardiogenic shock
Tamara Ni hIci1, Henry Mp Boardman2, Kamran Baig3
1Cardiothoracic Surgery, Morriston Hospital, Swansea, UK.
The Cochrane Database of Systematic Reviews
|June 5, 2020
Summary
Mechanical assist devices (MADs) show no survival benefit for acute cardiogenic shock (CS) patients. Further research is needed to optimize their use and risk stratification in critical care settings.
Area of Science:
- Cardiology
- Critical Care Medicine
- Medical Devices
Background:
- Cardiogenic shock (CS) is a life-threatening condition characterized by end-organ hypoperfusion due to cardiac dysfunction.
- Refractory CS, despite maximal medical management, carries a near 100% mortality rate.
- Mechanical assist devices (MADs) offer mechanical circulatory support (MCS) to maintain organ perfusion and reduce cardiac workload.
Purpose of the Study:
- To evaluate the efficacy of MADs in improving survival rates for patients experiencing acute cardiogenic shock.
- To determine if MCS provides a survival advantage compared to standard intensive care management.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials (RCTs) identified through comprehensive database searches (CENTRAL, MEDLINE, Embase, Web of Science).
- Included RCTs compared MADs against best current intensive care management, including intra-aortic balloon pumps and inotropic support.
- Primary outcomes focused on survival to discharge, 30 days, and 1 year; secondary outcomes included quality of life and adverse events.
Main Results:
- Five RCTs involving 162 participants were analyzed, focusing on 30-day survival due to limited data for longer-term outcomes.
- MADs demonstrated a potential, but uncertain, effect on 30-day survival (RR 1.01, 95% CI 0.76 to 1.35).
- Complications like sepsis, bleeding, and thromboembolism were observed in both MAD and control groups, precluding pooled analysis due to inconsistent reporting.
Conclusions:
- Current evidence from this review does not support a survival benefit of MCS through MADs in acute CS patients.
- Ongoing clinical trials are investigating potential reasons for the lack of benefit, including technology utilization, risk stratification, and protocol optimization.
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