Mortality in patients with cardiogenic shock associated with the use of microaxial flow pump: a systematic review and meta-analysis

Paul E. Hernández-Montes, Departamento de Medicina, Centro de Salud Juan Escutia, Unidad Académica de Medicina de la Universidad Autónoma de Nayarit, Tepic, Nayarit, México
Edgar D. Guzmán-Ríos, Departamento de Medicina, Centro de Justicia Familiar, Unidad Académica de Medicina de la Universidad Autónoma de Nayarit, Tepic, Nayarit, México
Marco F. Flores-Reyes, Departamento de Investigación, División de Investigación Básica, Instituto Nacional de Medicina Genómica, Universidad Autónoma de Nayarit, Tepic, Nayarit, México
Erick Ramírez-García, Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Facultad de Medicina de la Benemérita Universidad Autónoma de Puebla, Cuidad de México, México
Lenyn D. Montes-Sevilla, Departamento de Cirugía, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Unidad Académica de Medicina de la Universidad Autónoma de Nayarit, Cuidad de México, México
Osmara Morales-Hernández, Departamento de Dermatología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Centro Interdisciplinario de Ciencias de la Salud Milpalta IPN, Ciudad de México, México
Gilberto H. Acosta-Gutiérrez, Unidad de Servicio Social de Investigación, Departamento de Medicina, Instituto de Ciencias Biomédicas, Universidad Autónoma de Ciudad Juárez, Juárez, Chihuahua, México

In this article we aim to evaluate the impact of the microaxial flow pump on mortality in patients with cardiogenic shock associated with acute myocardial infarction through a systematic review and meta-analysis of clinical trials and cohort studies. Patients with acute myocardial infarction, both with and without ST-segment elevation, associated with cardiogenic shock and treated with a microaxial flow pump, were included. Mortality data and implantation time of the device were reported. Patients with more than 24 hours of shock progression, those with other shock etiologies, patients with mechanical complications from acute myocardial infarction, and other comorbidity, were excluded. The search was conducted in PubMed and Web of Science databases for articles published from 2019 until November 10, 2024. Risk of bias was evaluated using the RoB 2 tool and the ROBINS-E, while statistical analysis was performed using Review Manager 5.4.1 software. A total of 1000 patients from five studies were included. The use of the microaxial flow pump was associated with a reduction in mortality compared to placebo (OR: 0.6; 95%CI: 0.42-0.85; p = 0.005). However, there were no significant differences in mortality related to the timing of the microaxial flow pump implantation (before, during, or after percutaneous coronary intervention) (OR: 0.85; 95%CI: 0.59-1.22; p = 0.37). Patients with cardiogenic shock have gained access to various treatment opportunities that were not available until recently. The results suggest that the microaxial flow pump is a therapeutic option in these patients with significant effects on mortality.

Keywords: Cardiogenic shock. Microaxial flow pump. Mechanical circulatory support. Mortality. Systematic review.