CANCARE RESEARCH
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An automated research-discovery feed. Summaries are based on published abstracts and are not clinical recommendations.
Temporary Right Ventricular Mechanical Circulatory Support Devices in Acute Right Ventricular Failure and Cardiogenic Shock: A Cross-Device Systematic Review and Single-Arm Meta-Analysis.
Clinical takeaway These pooled estimates describe outcomes and complication burden in selected patients receiving temporary RV support. They cannot establish benefit over alternative care or identify a superior device.
Summary & abstract
Study summary
This single-arm meta-analysis included 106 studies and 4653 adults receiving temporary mechanical support for acute right ventricular failure or RV-predominant cardiogenic shock. Pooled survival to discharge was 60.4% (95% CI 56.0–64.7), with a wide prediction interval of 34.4%–81.6%; separately pooled 30-day mortality was 30.1% (95% CI 24.1–36.9). Pooled bleeding, renal complications, and stroke rates were 36.5%, 46.6%, and 14.5%, respectively. Concurrent left-sided support was reported in 85.8% of patients with available data, limiting applicability to isolated primary RV shock; these descriptive findings do not establish treatment benefit or comparative device effectiveness.
Study limitation: Heterogeneous treated cohorts, frequent concurrent left-sided support, and inclusion of 57 conference-abstract studies limit certainty and generalizability.
Published abstract
BACKGROUND: Evidence for temporary right ventricular assist devices (tRVADs) is fragmented. We characterized outcomes among adults receiving temporary support for acute right ventricular (RV) failure or RV-predominant cardiogenic shock. METHODS: MEDLINE, Embase, CENTRAL, and ClinicalTrials.gov were searched from inception to June 2026. Arm-level outcome proportions were pooled on the logit scale using three-level random-effects models, with arms nested within studies. Device-stratified estimates, meta-regression, and sensitivity analyses were examined. RESULTS: We included 106 studies (119 device arms; 4653 patients), including 57 conference-abstract studies (53.8%). Concurrent left-sided support was reported in 85.8% of patients with available data; post-LVAD RV failure predominated in 47.5% of arms. Separately pooled survival to discharge was 60.4% (95% CI 56.0-64.7; 63 arms), successful weaning 60.6% (54.8-66.2; 68 arms), and 30-day mortality 30.1% (24.1-36.9; 31 arms). The survival prediction interval was wide (34.4%-81.6%). Pooled bleeding, renal complications (acute kidney injury and/or renal replacement therapy, as reported), and stroke were 36.5%, 46.6%, and 14.5%, respectively. Device-stratified estimates were vulnerable to confounding. No meta-regression association remained significant after multiplicity correction. CONCLUSIONS: These descriptive estimates characterize selected, heterogeneous treated cohorts, predominantly receiving left-sided or biventricular support; they do not establish treatment benefit or comparative device effectiveness. Complication rates were high. Applicability to isolated primary RV shock is limited. Standardized prospective data are needed to inform patient selection, timing, and device strategy. TRIAL REGISTRATION: PROSPERO registration number: CRD420261406088.
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Efficacy and safety of nafamostat mesilate for anticoagulation during ECMO/CRRT: insight from the integrated meta-analysis and FAERS pharmacovigilance study.
Clinical takeaway The pooled bleeding association is relevant to extracorporeal-support care, but does not establish an ECMO-specific benefit. Nonsignificant filter-lifespan findings do not demonstrate equivalence.
Summary & abstract
Study summary
This meta-analysis included 17 studies involving 1,893 patients, comparing nafamostat with sodium citrate, unfractionated heparin, or no anticoagulation during ECMO/CRRT. Nafamostat was associated with fewer bleeding events (odds ratio 0.61; 95% confidence interval 0.43–0.86). Filter lifespan did not differ significantly between groups (mean difference 1.29 hours; 95% confidence interval −1.09 to 3.66). A separate FAERS analysis included 24,238 reports across the three anticoagulants and identified nafamostat reporting signals for disseminated intravascular coagulation, gastrointestinal hemorrhage, and decreased platelet count; these are reporting signals rather than comparative clinical risks.
Study limitation: The abstract does not separate ECMO from CRRT results or report mortality findings, limiting cardiac ICU interpretation.
Published abstract
BACKGROUND: Extracorporeal membrane oxygenation (ECMO) and continuous renal replacement therapy (CRRT) require a balance between maintaining circuit patency and minimizing bleeding risk. Nafamostat mesilate (NM) is a short-acting anticoagulant with distinctive pharmacokinetic properties, including rapid metabolism and a short half-life, which may reduce prolonged systemic anticoagulant exposure. These characteristics make NM a potential alternative to conventional anticoagulation strategies, particularly for patients at high risk of bleeding. This study aimed to systematically evaluate the efficacy and safety of NM as an anticoagulant for ECMO/CRRT. METHODS: PubMed, Embase, the Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data were systematically searched for randomized controlled trials and cohort studies comparing NM with sodium citrate, unfractionated heparin (UFH), or no anticoagulation. A meta-analysis was conducted to evaluate filter lifespan, bleeding events, thromboembolic events, and 28-day/intensive care unit (ICU) mortality. Reporting characteristics and potential safety signals for the three anticoagulants were also compared using data from the U.S. Food and Drug Administration Adverse Event Reporting System (FAERS). RESULTS: The meta-analysis included 17 studies involving 1,893 patients. Filter lifespan did not differ significantly between the NM and control groups (mean difference [MD] = 1.29 h; 95% confidence interval [CI], -1.09-3.66), whereas the risk of bleeding events was significantly lower in the NM group (odds ratio [OR] = 0.61; 95% CI, 0.43-0.86). Subgroup analyses showed that NM was associated with a significantly lower risk of bleeding than sodium citrate (OR = 0.53; 95% CI, 0.31-0.90) and no anticoagulation (OR = 0.41; 95% CI, 0.19-0.90); sensitivity analyses supported the robustness of this finding. The FAERS analysis included 24,238 reports, comprising 233 for NM, 1,612 for sodium citrate, and 22,393 for UFH, with distinct reporting profiles observed among the three anticoagulants. Representative signals for NM included disseminated intravascular coagulation (n = 17; ROR = 112.68, 95% CI: 69.69-182.19), gastrointestinal hemorrhage (n = 12; ROR = 15.44, 95% CI: 8.74-27.29), and decreased platelet count (n = 13; ROR = 7.52, 95% CI: 4.35-13.00). CONCLUSION: NM may reduce bleeding risk while maintaining a filter lifespan comparable to that achieved with other anticoagulation strategies, potentially providing an individualized anticoagulation option for patients at high risk of bleeding. In clinical practice, coagulation abnormalities, changes in platelet counts, and bleeding-related events should be closely monitored.
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Associated factors for in-hospital mortality in patients with fulminant myocarditis: a systematic review and meta-analysis.
Clinical takeaway These findings identify potential prognostic markers in fulminant myocarditis, but do not establish causality or treatment benefit. The immunoglobulin association is particularly fragile.
Summary & abstract
Study summary
This systematic review pooled 26 retrospective cohorts involving 4,890 patients with fulminant myocarditis to examine associations with all-cause in-hospital mortality. Cardiac arrest or CPR was associated with higher mortality odds (OR 2.57, 95% CI 1.49–4.44), while LVEF was inversely associated (OR 0.94, 95% CI 0.90–0.97). Age, lactate and cTnI also showed positive associations, while intravenous immunoglobulin therapy showed an inverse association. Evidence certainty was low for age and cTnI and very low for the other significant factors; lactate and immunoglobulin estimates were unstable in sensitivity analyses.
Study limitation: All included cohorts were retrospective, and most significant associations had very-low-certainty evidence.
Published abstract
BACKGROUND: Fulminant myocarditis (FM) progresses rapidly and carries high all-cause in-hospital mortality. Patients in the early phase often develop cardiogenic shock and malignant ventricular arrhythmias, with widely varying mortality rates reported across studies. Existing single-center cohorts yield conflicting prognostic findings with marked cross-cohort heterogeneity, and no standardized meta-analysis with GRADE certainty grading has been published to guide risk stratification. This meta-analysis pooled prognostic associations of all-cause in-hospital mortality in FM to inform acute risk evaluation and personalized care. METHODS: Eleven Chinese and English electronic databases were searched from database establishment through June 2025. Eligible studies were observational cohorts reporting prognostic associations of all-cause in-hospital mortality among FM patients. Two independent reviewers completed screening, data extraction and quality assessment separately. The Newcastle-Ottawa Scale (NOS) and AHRQ checklist were adopted to evaluate methodological quality. Pooled analyses were performed via the statsmodels package in Python, and the GRADE framework was applied to rate the certainty of evidence. RESULTS: 26 retrospective cohort studies with 4,890 FM patients were enrolled. Ten potential factors were meta-analyzed, of which six showed statistically significant associations with in-hospital mortality (P < 0.05), including age (OR = 1.03, 95% CI: 1.02-1.04), cardiac arrest or CPR (OR = 2.57, 95% CI: 1.49-4.44), lactate (OR = 1.08, 95% CI: 1.00-1.16), cTnI (OR = 1.04, 95% CI: 1.01-1.07), LVEF (OR 0.94, 95% CI 0.90-0.97), and intravenous immunoglobulin therapy (OR = 0.12, 95% CI: 0.02-0.86). CK-MB, serum creatinine, total bilirubin, and VT/VF showed no statistically significant association (all P > 0.05). GRADE evidence ratings indicated low-certainty evidence for age and cTnI, and very-low-certainty evidence for the remaining significant factors. Sensitivity analyses indicated unstable pooled estimates for lactate and intravenous immunoglobulin therapy. CONCLUSIONS: Four factors showed positive associations with elevated all-cause in-hospital mortality. LVEF was inversely associated with mortality, whereas the inverse association for IVIG represents a fragile treatment-related signal. These findings may inform acute risk screening, but most associations were supported by low or very low certainty evidence and should not be interpreted as causal. All included data were derived from retrospective cohorts. Standardized multicenter prospective studies are required to verify these prognostic associations. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261399446, identifier CRD420261399446.
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Corticosteroid therapy in cardiogenic shock: A systematic review and meta-analysis.
Clinical takeaway The available evidence does not establish whether corticosteroids affect acute mortality in cardiogenic shock. Potential adverse-outcome signals also remain highly uncertain.
Summary & abstract
Study summary
This systematic review compared corticosteroids with placebo or usual care in adults with cardiogenic shock. Eight studies were included, but the primary analysis comprised three observational studies of clearly defined cardiogenic shock. Unadjusted acute mortality showed no clear effect (risk ratio 1.05, 95% confidence interval 0.98–1.13), with high residual-confounding risk and very low evidence certainty. Weak evidence suggested increased hyperglycaemia and hospital-acquired infection, but definitions varied and certainty was very low. The authors concluded that evidence was insufficient to determine corticosteroids’ effect on acute mortality.
Study limitation: The primary analysis relied on three observational studies, with substantial clinical heterogeneity and high risk of residual confounding.
Published abstract
INTRODUCTION: Relative adrenal insufficiency and inflammation are associated with increased mortality in cardiogenic shock. In other shock states such as sepsis, guidelines recommend the administration of corticosteroids. METHODS: We conducted a pre-registered (CRD420251042819) systematic review and meta-analysis, searching MEDLINE, Embase and Cochrane Central on 21 June 2025. We included randomised controlled trials and observational studies of adult patients with cardiogenic shock which compared corticosteroids to placebo or usual care. The primary outcome was acute mortality. RESULTS: Of 3242 studies screened, eight studies (four randomised controlled trials and four observational cohort studies) were included with three observational studies of clearly-defined cardiogenic shock included in the primary analysis. There was substantial clinical heterogeneity across included studies of populations, interventions and observed mortality. Observational studies suggested between 7% and 29% of patients with cardiogenic shock received systemic corticosteroids. There was no evidence of an effect on acute mortality in unadjusted analysis (Risk Ratio = 1.05, 95% CI 0.98-1.13, p = 0.17), but there was high risk of residual confounding and a very low certainty of evidence. There was weak evidence of increased rates of hyperglycaemia and hospital-acquired infection, but this was defined heterogeneously and the certainty of evidence was very low. CONCLUSION: Our conclusions are limited by low study numbers, heterogeneity and uncertainty. There is insufficient evidence to determine the effect of corticosteroid use on acute mortality in cardiogenic shock. Further high-quality research is needed to assess the effect of corticosteroids on mortality in patients with cardiogenic shock.
AI summary and clinical bottom line, with automated source checks. Consult the original paper before applying findings.