Resource utilisation associated with extracorporeal membrane oxygenation versus microaxial flow pump for infarct-related cardiogenic shock.

Abstract

Background: Microaxial flow pump and venoarterial extracorporeal membrane oxygenation (VA-ECMO) are increasingly used in infarct-related cardiogenic shock (AMICS). This study provides a comparative overview of real-world resource utilisation associated with these devices (PROSPERO: CRD42024505174).

Methods: EMBASE, MEDLINE and Cochrane Library were sought from inception to 13-11-2024 for studies reporting at least one primary outcome, including intensive care unit (ICU) length of stay (LOS), hospital LOS, in-hospital costs and discharge destination. In-hospital mortality was included as secondary outcome. This study was guided by the PRISMA-2020 guideline. Study selection and data extraction were independently performed by two researchers. Risk-of-bias assessments were done using the Newcastle-Ottawa-Scale. Data were pooled using random-effect models.

Results: In total, 12 retrospective cohorts were identified encompassing 92,262 microaxial flow pump- and 16,474 VA-ECMO patients data. The meta-analysis of hospital LOS and in-hospital costs revealed favourable results for the microaxial flow pump, with mean differences (MD) of -5.3 days (95%CI: -6.6, -4.1) and -$113,983 (95%CI: -$143,153, -$84,812) respectively. Microaxial flow pump survivors were also 45% more likely to be discharged home (95%CI: 1.28 - 1.64). ICU-LOS was reported by one study, reporting a 10 days MD in favour of the microaxial flow pump. The averaged in-hospital mortality rates were 44% and 57% for the microaxial flow pump and VA-ECMO respectively. An inherent limitation of observational studies is confounding by indication.

Conclusions: Microaxial flow pump was associated with lower resource utilisation compared to VA-ECMO. Resource utilisation should be incorporated in prospective RCTs and taken into account when considering these devices.