D-120 | Unloading the Failing Heart: Short-Term Mortality Outcomes of Left Ventricular Support Strategies With and Without ECMO

Background: Cardiogenic shock carries high short-term mortality despite advances in mechanical circulatory support (MCS).Extracorporeal membrane oxygenation (ECMO) provides rapid hemodynamic and respiratory support but increases left ventricular (LV) afterload, which may worsen myocardial injury.Several LV unloading strategies-alone or combined with ECMO-have been proposed, but their effect on short-term mortality remains unclear.Methods: A PubMed search from inception to December 20, 2025 was performed using terms including ECMO, IMPELLA, IABP, and ECPELLA.A generic inverse variance random-effects model was used.Dichotomous outcomes were reported as odds ratios (OR).Results: Of 28 identified systematic reviews and meta-analyses, 5 were included.Short-term (30-day) mortality was analyzed.IABP was associated with lower short-term mortality compared with IMPELLA (OR 0.80 [0.68-0.95],P=0.01).ECMO plus IABP also reduced mortality versus ECMO alone (OR 0.61 [0.47-0.80],P=0.0003).IABP was linked to less bleeding than IMPELLA (OR 0.44 [0.37-0.51],P<0.00001).No significant mortality difference was found between ECMO+IMPELLA and ECMO+IABP (OR 0.82 [0.56-1.20],P=0.30).Conclusions: IABP is associated with reduced short-term mortality compared with IMPELLA and improves outcomes when combined with ECMO versus ECMO alone.However, no mortality difference exists between IMPELLA and IABP when each is used with ECMO.