Outcomes of VA-ECMO with and without Left Centricular (LV) Decompression Using Intra-Aortic Balloon Pumping (IABP) versus Other LV Decompression Techniques: A Systematic Review and Meta-Analysis

Background Left ventricular decompression is the primary method for solving VA-ECMO-induced LV afterload increase, but the effect of specific methods on patient outcomes and complications is unknown. Material/Methods We searched for all published reports conducted in patients undergoing ECMO combined with LVD. Statistical analyses were performed using Stata 12.0. Results The results showed that the risk of death with ECMO combined with LVD was 29% lower than that with ECMO alone (OR=0.71, 95% CI: 0.56–0.89, I2=59.5%, P<0.001). Although the risk of death with ECMO combined other LV decompression techniques was higher than that with ECMO combined with IABP, the difference was not statistically significant (OR=1.27, 95% CI: 0.86–1.87, I2=44.0%, P=0.057). In addition, the ORs values of hemorrhage, stroke/acute episodes, lower-limb ischemia, and hemolysis for ECMO combined with LVD were 0.69 (0.66–0.71), 0.82 (0.78–0.89), 0.71 (0.30–1.66), and 0.48 (0.16–1.39), respectively. The risk of complications, such as stroke/TIA, limb ischemia, and hemolysis, of ECMO combined with IABP was lower than that of ECMO combined other LV decompression techniques, and the risk of bleeding was higher for ECMO combined with IABP. Conclusions ECMO combined with LVD is more beneficial than using ECMO alone and helps to lower patient mortality.

[1]  Zachary Shinar.  Is the "Unprotected Heart" a clinical myth? Use of IABP, Impella, and ECMO in the acute cardiac patient. , 2019, Resuscitation.

[2]  P. Nordbeck,et al.  Impella CP use in patients with non‐ischaemic cardiogenic shock , 2019, ESC heart failure.

[3]  Y. Beşir,et al.  Should ECMO be used in cardiogenic shock? , 2019, Critical Care.

[4]  W. Kim,et al.  Outcomes of Coronary Artery Bypass Grafting after Extracorporeal Life Support in Patients with Cardiac Arrest or Cardiogenic Shock , 2019, The Korean journal of thoracic and cardiovascular surgery.

[5]  Yongnan Li,et al.  Does VA-ECMO Plus Impella Work in Refractory Cardiogenic Shock? , 2019, JACC. Heart failure.

[6]  L. Hajjar,et al.  Mechanical Circulatory Support Devices for Cardiogenic Shock: State of the Art , 2019, Critical Care.

[7]  J. Møller,et al.  Impella CP or VA-ECMO in profound cardiogenic shock: left ventricular unloading and organ perfusion in a large animal model. , 2019, EuroIntervention : journal of EuroPCR in collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology.

[8]  N. Al-Attar,et al.  Mechanical circulatory support for refractory cardiogenic shock post-acute myocardial infarction-a decade of lessons. , 2019, Journal of thoracic disease.

[9]  Shengshou Hu,et al.  Concurrent initiation of intra-aortic balloon pumping with extracorporeal membrane oxygenation reduced in-hospital mortality in postcardiotomy cardiogenic shock , 2019, Annals of Intensive Care.

[10]  V. Falk,et al.  Temporary mechanical circulatory support for refractory heart failure: the German Heart Center Berlin experience. , 2019, Annals of cardiothoracic surgery.

[11]  A. Ariza-Solé,et al.  The role of perioperative cardiorespiratory support in post infarction ventricular septal rupture-related cardiogenic shock , 2018, European heart journal. Acute cardiovascular care.

[12]  P. Leprince,et al.  Ischemic and hemorrhagic brain injury during venoarterial-extracorporeal membrane oxygenation , 2018, Annals of Intensive Care.

[13]  A. Fiedler,et al.  Impella Placement Guided by Echocardiography Can Be Used as a Strategy to Unload the Left Ventricle During Peripheral Venoarterial Extracorporeal Membrane Oxygenation. , 2018, Journal of cardiothoracic and vascular anesthesia.

[14]  S. Blankenberg,et al.  Unloading of the Left Ventricle During Venoarterial Extracorporeal Membrane Oxygenation Therapy in Cardiogenic Shock. , 2018, JACC. Heart failure.

[15]  L. Hellgren,et al.  Survival after refractory cardiogenic shock is comparable in patients with Impella and veno-arterial extracorporeal membrane oxygenation when adjusted for SAVE score , 2018, European heart journal. Acute cardiovascular care.

[16]  Shengshou Hu,et al.  Concurrent Implantation of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock , 2018, Artificial organs.

[17]  Yen-Wen Wu,et al.  Implementation of extracorporeal membrane oxygenation before primary percutaneous coronary intervention may improve the survival of patients with ST-segment elevation myocardial infarction and refractory cardiogenic shock. , 2018, International journal of cardiology.

[18]  Bingren Gao,et al.  Effect of an intra-aortic balloon pump with venoarterial extracorporeal membrane oxygenation on mortality of patients with cardiogenic shock: a systematic review and meta-analysis† , 2018, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[19]  L. Bellumkonda,et al.  Evolving Concepts in Diagnosis and Management of Cardiogenic Shock. , 2018, The American journal of cardiology.

[20]  A. Mebazaa,et al.  Management of cardiogenic shock complicating myocardial infarction , 2018, Intensive Care Medicine.

[21]  H. Shimokawa,et al.  Clinical determinants of successful weaning from extracorporeal membrane oxygenation in patients with fulminant myocarditis , 2018, ESC heart failure.

[22]  S. McGrane,et al.  Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock. , 2018, JACC. Heart failure.

[23]  J. Wald,et al.  Trends in mechanical circulatory support use and hospital mortality among patients with acute myocardial infarction and non-infarction related cardiogenic shock in the United States , 2018, Clinical Research in Cardiology.

[24]  Y. Naka,et al.  A continuous‐flow external ventricular assist device for cardiogenic shock: Evolution over 10 years , 2018, The Journal of thoracic and cardiovascular surgery.

[25]  P. Demondion,et al.  Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation , 2018, European heart journal. Acute cardiovascular care.

[26]  F. Roubille,et al.  Circulatory Support with Extracorporeal Membrane Oxygenation and/or Impella for Cardiogenic Shock During Myocardial Infarction , 2017, ASAIO journal.

[27]  M. Jozwiak,et al.  Norepinephrine exerts an inotropic effect during the early phase of human septic shock , 2017, British journal of anaesthesia.

[28]  D. Adams,et al.  Selective implantation of durable left ventricular assist devices as primary therapy for refractory cardiogenic shock , 2017, The Journal of thoracic and cardiovascular surgery.

[29]  P. Centofanti,et al.  Left Ventricular Unloading during Peripheral Extracorporeal Membrane Oxygenator Support: A Bridge To Life In Profound Cardiogenic Shock. , 2017, The journal of extra-corporeal technology.

[30]  Hollmann D. Aya,et al.  What is the impact of the fluid challenge technique on diagnosis of fluid responsiveness? A systematic review and meta-analysis , 2017, Critical Care.

[31]  A. Artigas,et al.  Systematic review and meta-analysis of complications and mortality of veno-venous extracorporeal membrane oxygenation for refractory acute respiratory distress syndrome , 2017, Annals of Intensive Care.

[32]  D. Brodie,et al.  Incidence and Implications of Left Ventricular Distention During Venoarterial Extracorporeal Membrane Oxygenation Support , 2017, ASAIO journal.

[33]  Sunil V. Rao,et al.  Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock , 2017, Circulation. Cardiovascular interventions.

[34]  K. Werdan,et al.  IABP plus ECMO-Is one and one more than two? , 2017, Journal of thoracic disease.

[35]  S. Blankenberg,et al.  Concomitant implantation of Impella® on top of veno‐arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock , 2017, European journal of heart failure.

[36]  R. Cheng,et al.  Device Strategies for Patients in INTERMACS Profiles 1 and 2 Cardiogenic Shock: Double Bridge With Extracorporeal Membrane Oxygenation and Initial Implant of More Durable Devices , 2017, Artificial organs.

[37]  H. Yasunaga,et al.  The Effect of Intraaortic Balloon Pumping Under Venoarterial Extracorporeal Membrane Oxygenation on Mortality of Cardiogenic Patients: An Analysis Using a Nationwide Inpatient Database , 2016, Critical care medicine.

[38]  J. Mehilli,et al.  Retrospective analysis of circulatory support with the Impella CP® device in patients with therapy refractory cardiogenic shock. , 2016, International journal of cardiology.

[39]  A. Lichtenberg,et al.  Implanting permanent left ventricular assist devices in patients on veno-arterial extracorporeal membrane oxygenation support: do we really need a cardiopulmonary bypass machine? , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.

[40]  N. Chou,et al.  Effects of Additional Intra-aortic Balloon Counter-Pulsation Therapy to Cardiogenic Shock Patients Supported by Extra-corporeal Membranous Oxygenation , 2016, Scientific Reports.

[41]  P. Leprince,et al.  The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock , 2016, Intensive Care Medicine.

[42]  Holger Thiele,et al.  Clinical picture and risk prediction of short‐term mortality in cardiogenic shock , 2015, European journal of heart failure.

[43]  J. Terrovitis,et al.  Current and future applications of the intra-aortic balloon pump , 2014, Current opinion in cardiology.

[44]  Xiaojing Ma,et al.  Combining ECMO with IABP for the treatment of critically Ill adult heart failure patients. , 2014, Heart, lung & circulation.

[45]  A. Rocchini,et al.  Decompression of the left atrium during extracorporeal membrane oxygenation using a transseptal cannula incorporated into the circuit* , 2006, Critical care medicine.

[46]  S. Prasad,et al.  Right ventricular assist device with membrane oxygenator support for right ventricular failure following implantable left ventricular assist device placement. , 2016, European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery.