ReviewCureus2026
Comparative Efficacy and Safety of Veno-Arterial Extracorporeal Membrane Oxygenation (VA-ECMO) Versus Impella for Cardiogenic Shock: A Systematic Review and Meta-Analysis.
Review in Cureus, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
0 citing papers in PubMed.
No citing paper in PubMed yet.
Corrections and comments
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Authors and funding
11 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
This systematic review and meta-analysis aimed to systematically evaluate the comparative efficacy and safety of Impella and veno-arterial extracorporeal membrane oxygenation (VA-ECMO) in the management of cardiogenic shock (CS). A systematic search of the Cochrane Controlled Register of Trials (CENTRAL), Medical Literature Analysis and Retrieval System Online (MEDLINE), and Scopus was conducted from inception to October 2025 to identify non-randomized and randomized studies comparing Impella and VA-ECMO in adults with CS. The review protocol was registered with the International Prospective Register of Systematic Reviews (PROSPERO) database (CRD420251158340). The primary outcome was short-term mortality. The secondary outcomes included stroke, major bleeding, and limb ischemia. The risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions (ROBINS-I) tool. Pooled risk ratios (RRs) with 95% confidence intervals (CIs) were calculated using a random-effects model with Knapp-Hartung adjustment. Ten non-randomized observational studies involving 5364 patients were included. The overall risk of bias was serious across all studies, primarily due to profound confounding by indication. The meta-analysis revealed no statistically significant difference in the risk of short-term mortality between patients treated with Impella and VA-ECMO (RR, 0.92; 95% CI, 0.76-1.10; p=0.30), although substantial heterogeneity was present (I² = 64.5%). In contrast, Impella use was associated with a significantly lower risk of stroke (RR, 0.52; 95% CI, 0.36-0.75), major bleeding (RR, 0.53; 95% CI, 0.49-0.57), and limb ischemia (RR, 0.55; 95% CI, 0.45-0.68). Based on observational data with a very low certainty of evidence, the use of Impella was not associated with a survival benefit compared to VA-ECMO but was associated with a more favourable safety profile. These findings are limited by confounding factors, and the choice between these devices should be individualized based on the required level of cardiorespiratory support and patient-specific risk factors. Adequately powered randomized controlled trials (RCTs) are required.
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