Axillary or Subclavian Impella 5.0 Support in Cardiogenic Shock: A Systematic Review and Meta-analysis

Summary data around survival and adverse events of cardiogenic shock (CS) patients supported with axillary or subclavian artery 5.0 Impella are presently unavailable. We performed a systematic search of studies reporting the outcomes of axillary or subclavian access 5.0 Impella for refractory CS in PubMed, EMBASE, and the Cochrane Library. The primary outcome was 30-day survival. Secondary outcomes included survival to next therapy and adverse events on support. Proportional meta-analysis was used to pool across studies. Of the 795 potential studies identified, 13 studies were included in the meta-analysis (n = 256 patients). The average age of patients across studies was 56 ± 5 years. Thirty-day survival for the overall cohort was 66% (95% CI: 59-73). Survival to the next therapy was 68% (95% CI: 60-76). The occurrence of adverse events over an average of 13 (95% CI: 12-14) days of support was the following: stroke 5.9%, hemolysis 27%, pump thrombosis 4.4%, limb ischemia 0.1%, major bleeding 5.4%, device malfunction 10.6%, exchange 6.6%, and infection 14%. In this systematic review and meta-analysis, we report survival and adverse event rates of axillary or subclavian access 5.0 Impella for CS. Such summary data can inform clinician decision-making.