Temporary mechanical circulatory support after return of spontaneous circulation following cardiac arrest: a systematic review and meta-analysis

BACKGROUND: Shock with cardiogenic involvement is common after return of spontaneous circulation (ROSC) following cardiac arrest. Temporary mechanical circulatory support (MCS) is increasingly used in acute myocardial infarction-related cardiogenic shock (AMI-CS), but its efficacy in post-cardiac arrest patients remains uncertain. METHODS: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing MCS (extracorporeal membrane oxygenation, intra-aortic ballon pump, or microaxial flow pump) versus standard care after ROSC. PubMed, Embase, and the Cochrane Central Register of Controlled Trials were searched through June 19, 2025. The primary outcome was survival at the longest follow-up. Frequentist estimates were complemented by a Bayesian meta-analysis. RESULTS: Fourteen RCTs enrolling 1,842 AMI-CS patients were identified, of whom 762 had achieved ROSC after in- or out-of-hospital cardiac arrest. In these patients, MCS did not improve survival at the longest follow-up (46 % with MCS vs 41 % with standard care; RR 1.10 [95 % CI, 0.94-1.29]; p = 0.23; I² = 0.0 %). Bayesian analysis (RR 1.13 [95 % CrI, 0.90-1.44]) showed an 88 % posterior probability of any survival benefit (absolute risk difference > 0 %) and a 56 % probability of a clinically relevant benefit (>5 %). In patients with no or cardiac arrest duration < 10 min, MCS improved survival (56 % vs 45 %; RR 1.25 [95 % CI, 1.06-1.47]; p = 0.007). MCS was associated with increased device-related complications. CONCLUSIONS: Routine use of temporary MCS does not improve survival in unselected cardiac arrest patients with AMI-CS and increased complication rates. Future research should target more carefully selected patients with lower risk of hypoxic-ischemic brain injury. REVIEW REGISTRATION: PROSPERO CRD42024566810.