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Canadian Journal of Anesthesia/Journal canadien d'anesthésie

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04.10.2022 | Review Article/Brief Review

Inotropes, vasopressors, and mechanical circulatory support for treatment of cardiogenic shock complicating myocardial infarction: a systematic review and network meta-analysis

verfasst von: Shannon M. Fernando, MD, MSc, Rebecca Mathew, MD, Behnam Sadeghirad, PharmD, MPH, PhD, Daniel Brodie, MD, Emilie P. Belley-Côté, MD, PhD, Holger Thiele, MD, Sean van Diepen, MD, MSc, Eddy Fan, MD, PhD, Pietro Di Santo, MD, Trevor Simard, MD, Juan J. Russo, MD, Alexandre Tran, MD, MSc, Bruno Lévy, MD, PhD, Alain Combes, MD, PhD, Benjamin Hibbert, MD, PhD, Bram Rochwerg, MD, MSc

Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie | Ausgabe 12/2022

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Abstract

Purpose

To compare the relative efficacy of supportive therapies (inotropes, vasopressors, and mechanical circulatory support [MCS]) for adult patients with cardiogenic shock complicating acute myocardial infarction.

Source

We conducted a systematic review and network meta-analysis and searched six databases from inception to December 2021 for randomized clinical trials (RCTs). We evaluated inotropes, vasopressors, and MCS in separate networks. Two reviewers performed screening, full-text review, and extraction. We used the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework to rate the certainty in findings. The critical outcome of interest was 30-day all-cause mortality.

Principal findings

We included 17 RCTs. Among inotropes (seven RCTs, 1,145 patients), levosimendan probably reduces mortality compared with placebo (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.33 to 0.87; moderate certainty), but primarily in lower severity shock. Milrinone (OR, 0.52; 95% CI, 0.19 to 1.39; low certainty) and dobutamine (OR, 0.67, 95% CI, 0.30 to 1.49; low certainty) may have no effect on mortality compared with placebo. With regard to MCS (eight RCTs, 856 patients), there may be no effect on mortality with an intra-aortic balloon pump (IABP) (OR, 0.94; 95% CI, 0.69 to 1.28; low certainty) or percutaneous MCS (pMCS) (OR, 0.96; 95% CI, 0.47 to 1.98; low certainty), compared with a strategy involving no MCS. Intra-aortic balloon pump use was associated with less major bleeding compared with pMCS. We found only two RCTs evaluating vasopressors, yielding insufficient data for meta-analysis.

Conclusion

The results of this systematic review and network meta-analysis indicate that levosimendan reduces mortality compared with placebo among patients with low severity cardiogenic shock. Intra-aortic balloon pump and pMCS had no effect on mortality compared with a strategy of no MCS, but pMCS was associated with higher rates of major bleeding.

Study registration

Center for Open Science (https://osf.io/ky2gr); registered 10 November 2020

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Titel: Inotropes, vasopressors, and mechanical circulatory support for treatment of cardiogenic shock complicating myocardial infarction: a systematic review and network meta-analysis
verfasst von: Shannon M. Fernando, MD, MSc
Rebecca Mathew, MD
Behnam Sadeghirad, PharmD, MPH, PhD
Daniel Brodie, MD
Emilie P. Belley-Côté, MD, PhD
Holger Thiele, MD
Sean van Diepen, MD, MSc
Eddy Fan, MD, PhD
Pietro Di Santo, MD
Trevor Simard, MD
Juan J. Russo, MD
Alexandre Tran, MD, MSc
Bruno Lévy, MD, PhD
Alain Combes, MD, PhD
Benjamin Hibbert, MD, PhD
Bram Rochwerg, MD, MSc
Publikationsdatum: 04.10.2022
Verlag: Springer International Publishing
Erschienen in: Canadian Journal of Anesthesia/Journal canadien d'anesthésie / Ausgabe 12/2022
Print ISSN: 0832-610X
Elektronische ISSN: 1496-8975
DOI: https://doi.org/10.1007/s12630-022-02337-7

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Inotropes, vasopressors, and mechanical circulatory support for treatment of cardiogenic shock complicating myocardial infarction: a systematic review and network meta-analysis