Declining Mechanical Circulatory Support Utilization in Cardiogenic Shock: National Trends and Device-Specific Mortality (2018-2022)

Document Type

Conference Proceeding

Publication Date

4-2026

Publication Title

Journal of the Society for Cardiovascular Angiography & Interventions

Abstract

Background: Mechanical circulatory support (MCS) is integral to cardiogenic shock management, yet contemporary real-world utilization patterns remain incompletely characterized. Methods: We analyzed 1,006,280 cardiogenic shock hospitalizations from the National Inpatient Sample (2018-2022) to examine temporal trends in MCS utilization and device-specific mortality outcomes. Devices included extracorporeal membrane oxygenation (ECMO), intraaortic balloon pump (IABP), Impella, and combination therapy. Results: Overall MCS utilization was 17.6%, with significant device distribution: IABP (54.0%), Impella (24.3%), ECMO (10.6%), and multiple devices (11.1%). From 2018-2022, total MCS use declined significantly (aOR per year 0.94, 95% CI 0.93-0.95), driven primarily by decreasing IABP utilization (aOR 0.93, 95% CI 0.91-0.94) and Impella use (aOR 0.97, 95% CI 0.95-0.99), while ECMO rates remained stable (p=0.870). In-hospital mortality varied dramatically by device: IABP 22.5%, Impella 38.3%, ECMO 43.7%, and multiple devices 43.7%. IABP demonstrated significant mortality benefit (aOR 0.60, 95% CI 0.57-0.62), while ECMO (aOR 2.37, 95% CI 2.14-2.44), Impella (aOR 1.31, 95% CI 1.24-1.38), and multiple devices (aOR 1.84, 95% CI 1.71- 1.99) were associated with increased mortality compared to no MCS. Patients receiving MCS were younger (mean 62.9 vs 65.9 years), predominantly male (69.4% vs 60.9%), and more likely treated at large teaching hospitals (86.1% vs 81.8%). Conclusions: MCS utilization in cardiogenic shock is declining despite expanding device options, with IABP remaining the most commonly used device. The substantial mortality differences likely reflect underlying patient selection bias, with ECMO and multiple devices reserved for the most critically ill patients with refractory shock, while IABP is used in less severe cases. Impella occupies an intermediate position, indicating use in moderate-severity shock. These findings underscore that device-specific mortality rates reflect patient acuity rather than device efficacy alone, emphasizing the need for severity-adjusted comparative effectiveness studies and risk-stratified MCS algorithms to guide optimal device selection in cardiogenic shock

Volume

5

Issue

4 Suppl

First Page

104949

Comments

SCAI (Society for Cardiovascular Angiography & Interventions 2026 Scientific Sessions, April 23-25, 2026, Montreal, Canada

Last Page

104949

DOI

10.1016/j.jscai.2026.104949

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