{"id":"0c8f513684dd","type":"article","url":"https://hartvaat.nl/2017/12/14/mechanische-ondersteuning-bij-cardiogene-shock-systematische-review-en-meta-anal/","title":"Mechanische ondersteuning bij cardiogene shock: systematische review en meta-analyse","title_en":"Percutaneous short-term active mechanical support devices in cardiogenic shock: a systematic review and collaborative meta-analysis of randomized trials.","category":"atriumfibrilleren","category_label":"Atriumfibrilleren","professions":["cardioloog"],"tags":["acuut-hartfalen","aficamten","atleten","bradycardie","cardiogene-shock","hypertrofische-cardiomyopathie","klepprothese","laminopathie","myocardinfarct","obesitas","plotse-hartdood","slaapapneu","takotsubo"],"journal":"European heart journal","doi":"10.1093/eurheartj/ehx363","source_url":"https://doi.org/10.1093/eurheartj/ehx363","authors":["Holger Thiele","Alexander Jobs","Dagmar M Ouweneel","Jose P S Henriques","Melchior Seyfarth","Steffen Desch","Ingo Eitel","Janine Pöss","Georg Fuernau","Suzanne de Waha"],"significance":7,"published":"2017-12-14","source_date":"2017-12-14","image":"","kennis":[],"congress":"","summary_en":"This systematic review and meta-analysis of short-term active mechanical circulatory support devices in cardiogenic shock found limited evidence for mortality benefit but significant complications, highlighting the need for the large randomized trials that followed.","created":"2026-07-03T10:27:03Z","updated":"2026-07-03T18:38:36Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"Systematische review en collaboratieve meta-analyse van kortetermijn actieve mechanische ondersteuningsdevices bij cardiogene shock. Referentie voor het device-selectiebeleid.","abstract_original":"AIMS: Evidence on the impact on clinical outcome of active mechanical circulatory support (MCS) devices in cardiogenic shock (CS) is scarce. This collaborative meta-analysis of randomized trials thus aims to investigate the efficacy and safety of percutanzeous active MCS vs. control in CS. METHODS AND RESULTS: Randomized trials comparing percutaneous active MCS to control in patients with CS were identified through searches of medical literature databases. Risk ratios (RR) and 95% confidence intervals (95% CI) were calculated to analyse the primary endpoint of 30-day mortality and device-related complications including bleeding and leg ischaemia. Mean differences (MD) were calculated for mean arterial pressure (MAP), cardiac index (CI), pulmonary capillary wedge pressure (PCWP), and arterial lactate. Four trials randomizing 148 patients to either TandemHeart™ or Impella® MCS (n = 77) vs. control (n = 71) were identified. In all four trials intra-aortic balloon pumping (IABP) served as control. There was no difference in 30-day mortality (RR 1.01, 95% CI 0.70 to 1.44, P = 0.98, I2 = 0%) for active MCS compared with control. Active MCS significantly increased MAP (MD 11.85 mmHg, 95% CI 3.39 to 20.31, P = 0.02, I2 = 32.7%) and decreased arterial lactate (MD - 1.36 mmol/L, 95% CI - 2.52 to - 0.19, I2 = 0%, P = 0.02) at comparable CI (MD 0.32, 95% CI - 0.24 to 0.87, P = 0.14, I2 = 44.1%) and PCWP (MD - 5.59, 95% -15.59 to 4.40, P = 0.14, I2 = 81.1%). No significant difference was observed in the incidence of leg ischaemia (RR 2.64, 95% CI 0.83 to 8.39, P = 0.10, I2 = 0%), whereas the rate of bleeding was significantly increased in MCS compared to IABP (RR 2.50, 95% CI 1.55 to 4.04, P < 0.001, I2 = 0%). CONCLUSION: Results of this collaborative meta-analysis do not support the unselected use of active MCS in patients with CS complicating AMI."}