Cardiology in critical care · Mechanical support in cardiogenic shock
Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock
| Design | Multicentre randomised controlled trial |
|---|---|
| Treatment | Microaxial flow pump with standard care |
| Control | Standard care alone |
| Population | 355 analysed patients with STEMI-related cardiogenic shock, median age 67 |
| Follow-up | 180 days |
| Primary endpoint | Death from any cause at 180 days |
| Result | Routine use of a microaxial flow pump reduced the risk of death from any cause at 180 days compared with standard care alone, among 179 and 176 patients respectively. Adverse events were more frequent in the pump group. Renal-replacement therapy was needed in 75 of 179 (41.9%) with the pump versus 47 of 176 (26.7%) with standard care — relative risk 1.98. |
| Secondary endpoints | Escalation to other mechanical support, renal replacement therapy, bleeding, limb ischaemia |
The routine use of a microaxial flow pump with standard care in the treatment of patients with STEMI-related cardiogenic shock led to a lower risk of death from any cause at 180 days than standard care alone.
The trial authors, in the published abstract
The first mechanical support device to show a mortality benefit in cardiogenic shock, after IABP-SHOCK II and both ECMO trials (ECMO-CS, ECLS-SHOCK) came up empty. The complication rate is substantial and the population narrow — STEMI-related shock specifically.
Møller JE, Engstrøm T, Jensen LO, et al. Microaxial Flow Pump or Standard Care in Infarct-Related Cardiogenic Shock. N Engl J Med 2024 Apr 18;390(15):1382-1393.