Safety and clinical outcomes of micro-axial intravascular flow pump compared to intra-aortic balloon pump in cardiogenic shock

Background: The micro-axial intravascular flow pump (mAFP) may potentially improve the prognosis of cardiogenic shock (CS). Despite its advanced hemodynamic profile, efficacy remains undetermined. Safety and mid-term outcomes were compared between the mAFP and intra-aortic balloon pump (IABP). Methods: This single-center, cross-sectional study retrospectively evaluated 205 consecutive patients treated using the IABP or mAFP at Osaka Medical and Pharmaceutical University from January 2017 to June 2023. After exclusion of those with CS who were treated with only extracorporeal membrane oxygenation (ECMO), patients who required IABP or mAFP were enrolled in the current study. The primary outcome was 180-day mortality. Secondary outcomes were major [major bleeding (Bleeding Academic Research Consortium criteria 3-5), limb ischemia and stroke] and other complications (hemolysis, thrombocytopenia, acute kidney impairment and requirement of renal replacement therapy). Those outcomes were compared between IABP and mAFP. Results: . IABP) (HR: 5.27, 95% CI: 1.71-16.30), age ≥75 years (HR: 2.80, 95% CI: 1.28-6.11) and ECMO use (HR: 8.34, 95% CI: 2.33-29.9) were independent predictors of other complications. Conclusions: Classical CS attained benefit from the mAFP, whereas it is still challenging for patients with severe CS, particularly OHCPA and requirement for ECMO. The use of mAFP was associated with more complications and its true impact on clinical outcomes remains to be determined.