Poster 102: Is Mechanical Circulatory Support Justified in Refractory Septic Shock? A Systematic Review and Emerging Evidence.

Background: The use of mechanical circulatory support (MCS) in septic shock (SS) has increased in recent years, however, literature focuses on patients with combined SS and cardiogenic shock. In consequence, its use in isolated SS remains purely empirical and unclear due to the limited published evidence.

Methods: A systematic review was conducted, using Pubmed and following the PRISMA guidelines; search was performed using predefined MeSH terms and Boolean operators to identify studies that evaluated mechanical circulatory support in adults with septic or distributive shock. Filters were applied: last five years, english or spanish language, human studies, and adult populations. The eligible studies included observational and interventional designs reporting relevant clinical outcomes. Title and abstract screening, followed by full text review were performed using predefined inclusion and exclusion criteria. Rigorous selection revealed limited high-quality evidence; in consequence of the limited number of eligible studies, a qualitative analysis of emerging evidence was conducted separately to provide contextual insights and explain the mechanisms behind the findings.

Outcome: A total of 356 results were identified; only one observational cohort study met inclusion criteria for the systematic review. This study was a multicenter observational cohort study in China, by Hu et al., which included 200 adult patients with refractory septic shock (RSS) complicated by septic cardiomyopathy (SC) treated with VA-ECMO; SC was defined by echocardiographic left ventricular systolic dysfunction and persistent hyperlactatemia despite the use of vasopressor therapy.
In-hospital mortality was 85% and 28-day survival 23%. Average VA-ECMO support duration 6.00 (2.00, 8.00) days. Successful weaning 37%. The most common causes of death: Septic shock (primary disease) 72% and Multiple organ dysfunction syndrome 23.5%. VA-ECMO related complications: Bleeding 6%; Neurological complications 4% and Lower limb ischemia 3.5%.
No eligible studies that evaluated MCS in isolated distributive SS without cardiac dysfunction were identified. Qualitative analysis of emerging evidence obtained from narrative reviews and case reports suggests that mechanical circulatory support may provide hemodynamic stabilization in selected patients with SC or hyperdynamic septic shock. However, outcomes suggest limited benefit in patients with isolated vasoplegic shock, demonstrating the clinical relevance of shock phenotyping.

Conclusion: High-quality evidence supporting the use of MCS in RSS, is extremely limited. VA-ECMO may be considered as a rescue therapy in selected cases of SC, while its use in isolated vasoplegic shock remains unsupported due to the limited number of solid evidence.