Zeyad Kholeif, n/a: No financial relationships to disclose
Background: Cardiogenic shock is a life-threatening condition marked by significant mortality and morbidity. Mechanical circulatory support devices, such as Impella and ECMO, serve as a temporary solution until either recovery or a surgical decision is made. We sought to conduct a meta-analysis to compare the outcomes in patients with cardiogenic shock.
Methods: We searched PubMed, Scopus, Web of Science, and Cochrane from inception until April 2025. We included studies comparing Impella vs ECMO in CS patients. The primary outcome was: In-hospital mortality. The secondary outcomes were: All-cause mortality, Intensive care unit (ICU) mortality, ICU length of stay, and complications, including bleeding events, peripheral vascular complications, acute kidney injury (AKI), renal replacement therapy, and stroke. Data were pooled using a random effect model; heterogeneity was assessed using the I² statistic.
Outcome: Fifteen observational studies with 22,618 patients were included. Impella was associated with significantly lower in-hospital mortality (Risk Ratio (RR): 0.90, 95% Confidence Interval (CI): 0.86–0.94). All-cause mortality was also lower with Impella (RR: 0.90, 95% CI: 0.81–0.99). ICU mortality favored Impella but was not statistically significant (RR: 0.87, 95% CI: 0.74–1.02). Impella significantly reduced ICU length of stay ( Mean difference (MD): -8.57 days, 95% CI: -13.93 to -3.21) and complications, including access site bleeding (RR: 0.43, 95% CI: 0.32–0.57), peripheral vascular complications (RR: 0.49, 95% CI: 0.37–0.65), AKI (RR: 0.81, 95% CI: 0.77–0.85), and stroke (RR: 0.37, 95% CI: 0.30–0.45).
Conclusion: This meta-analysis showed that Impella significantly decreased in-hospital mortality when deployed in patients presenting with cardiogenic shock due to different causes. In addition, Impella shows a significant reduction in all-cause mortality and fewer complications compared with ECMO.
