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

Overview

Journal Med Sci Monit

Specialties General Medicine
Pathology

Date 2020 Jul 31

PMID 32729556

Citations 5

Authors

Pan Pan

Peng Yan

Dawei Liu

Xiaoting Wang

Xiang Zhou

Yun Long

Kun Xiao

Weiguo Zhao

Lixin Xie

Longxiang Su

Affiliations

Soon will be listed here.

Abstract

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 AND 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.

Citing Articles

Impact of independent early stage extracorporeal cardiopulmonary resuscitation in the emergency department following the establishment of an extracorporeal life support team.

Liu Z, Yang Y, Song H, Liu W, Sun P, Lin C Heliyon. 2024; 10(1):e23411.

PMID: 38187318 PMC: 10770443. DOI: 10.1016/j.heliyon.2023.e23411.

2023 Chinese expert consensus on the impact of COVID-19 on the management of cardiovascular diseases.

Bai F, Pu J, Che W, Chen J, Chen M, Chen W Cardiol Plus. 2023; 8(2):82-102.

PMID: 37486153 PMC: 10358441. DOI: 10.1097/CP9.0000000000000043.

Use of Percutaneous Atrioseptotosmy for Left Heart Decompression During Veno-Arterial Extracorporeal Membrane Oxygenation Support: An Observational Study.

Delmas C, Vallee L, Bouisset F, Porterie J, Biendel C, Lairez O J Am Heart Assoc. 2022; 11(17):e024642.

PMID: 36000436 PMC: 9496417. DOI: 10.1161/JAHA.121.024642.

Sensitivity of ventricular systolic function to afterload during veno-arterial extracorporeal membrane oxygenation.

Ng P, Ma T, Ip A, Lee M, Ng A, Ngai C ESC Heart Fail. 2022; 9(5):3241-3253.

PMID: 35778858 PMC: 9715867. DOI: 10.1002/ehf2.13959.

Emerging Topics Update of the Brazilian Heart Failure Guideline - 2021.

Marcondes-Braga F, Moura L, Issa V, Vieira J, Rohde L, Simoes M Arq Bras Cardiol. 2021; 116(6):1174-1212.

PMID: 34133608 PMC: 8288520. DOI: 10.36660/abc.20210367.

References

Nersesian G, Hennig F, Muller M, Mulzer J, Tsyganenko D, Starck C . Temporary mechanical circulatory support for refractory heart failure: the German Heart Center Berlin experience. Ann Cardiothorac Surg. 2019; 8(1):76-83. PMC: 6379195. DOI: 10.21037/acs.2018.12.01. View

Gokalp O, Donmez K, Iner H, Gokalp G, Besir Y, Yesilkaya N . Should ECMO be used in cardiogenic shock?. Crit Care. 2019; 23(1):174. PMC: 6521371. DOI: 10.1186/s13054-019-2453-2. View

Le Guennec L, Cholet C, Huang F, Schmidt M, Brechot N, Hekimian G . Ischemic and hemorrhagic brain injury during venoarterial-extracorporeal membrane oxygenation. Ann Intensive Care. 2018; 8(1):129. PMC: 6301905. DOI: 10.1186/s13613-018-0475-6. View

Hajjar L, Teboul J . Mechanical Circulatory Support Devices for Cardiogenic Shock: State of the Art. Crit Care. 2019; 23(1):76. PMC: 6408785. DOI: 10.1186/s13054-019-2368-y. View

Chen K, Hou J, Tang H, Hu S . Concurrent Implantation of Intra-Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock. Artif Organs. 2018; 43(2):142-149. PMC: 6587979. DOI: 10.1111/aor.13317. View

Huang C, Hsu J, Wu Y, Ke S, Huang J, Chiu K . 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. Int J Cardiol. 2018; 269:45-50. DOI: 10.1016/j.ijcard.2018.07.023. View

Truby L, Takeda K, Mauro C, Yuzefpolskaya M, Garan A, Kirtane A . Incidence and Implications of Left Ventricular Distention During Venoarterial Extracorporeal Membrane Oxygenation Support. ASAIO J. 2017; 63(3):257-265. DOI: 10.1097/MAT.0000000000000553. View

Ma P, Zhang Z, Song T, Yang Y, Meng G, Zhao J . Combining ECMO with IABP for the treatment of critically Ill adult heart failure patients. Heart Lung Circ. 2013; 23(4):363-8. DOI: 10.1016/j.hlc.2013.10.081. View

Li Y, Yan S, Cai L, Zhang Q . Does VA-ECMO Plus Impella Work in Refractory Cardiogenic Shock?. JACC Heart Fail. 2019; 7(4):364. DOI: 10.1016/j.jchf.2018.12.009. View

10.

Keebler M, Haddad E, Choi C, McGrane S, Zalawadiya S, Schlendorf K . Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock. JACC Heart Fail. 2018; 6(6):503-516. DOI: 10.1016/j.jchf.2017.11.017. View

11.

Pappalardo F, Schulte C, Pieri M, Schrage B, Contri R, Soeffker G . Concomitant implantation of Impella on top of veno-arterial extracorporeal membrane oxygenation may improve survival of patients with cardiogenic shock. Eur J Heart Fail. 2016; 19(3):404-412. DOI: 10.1002/ejhf.668. View

12.

Mandawat A, Rao S . Percutaneous Mechanical Circulatory Support Devices in Cardiogenic Shock. Circ Cardiovasc Interv. 2017; 10(5). PMC: 5578718. DOI: 10.1161/CIRCINTERVENTIONS.116.004337. View

13.

Shinar Z . Is the "Unprotected Heart" a clinical myth? Use of IABP, Impella, and ECMO in the acute cardiac patient. Resuscitation. 2019; 140:205-206. DOI: 10.1016/j.resuscitation.2019.05.005. View

14.

Bellumkonda L, Gul B, Masri S . Evolving Concepts in Diagnosis and Management of Cardiogenic Shock. Am J Cardiol. 2018; 122(6):1104-1110. DOI: 10.1016/j.amjcard.2018.05.040. View

15.

Harjola V, Lassus J, Sionis A, Kober L, Tarvasmaki T, Spinar J . Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail. 2015; 17(5):501-9. DOI: 10.1002/ejhf.260. View

16.

Muller G, Flecher E, Lebreton G, Luyt C, Trouillet J, Brechot N . The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med. 2016; 42(3):370-378. DOI: 10.1007/s00134-016-4223-9. View

17.

Nuding S, Werdan K . IABP plus ECMO-Is one and one more than two?. J Thorac Dis. 2017; 9(4):961-964. PMC: 5418280. DOI: 10.21037/jtd.2017.03.73. View

18.

Moller-Helgestad O, Hyldebrandt J, Banke A, Rud C, Udesen N, Linde L . Impella CP or VA-ECMO in profound cardiogenic shock: left ventricular unloading and organ perfusion in a large animal model. EuroIntervention. 2018; 14(15):e1585-e1592. DOI: 10.4244/EIJ-D-18-00684. View

19.

Centofanti P, Attisani M, La Torre M, Ricci D, Boffini M, Baronetto A . Left Ventricular Unloading during Peripheral Extracorporeal Membrane Oxygenator Support: A Bridge To Life In Profound Cardiogenic Shock. J Extra Corpor Technol. 2017; 49(3):201-205. PMC: 5621585. View

20.

Lackermair K, Sattler S, Huber B, Grabmaier U, Weckbach L, Bauer A . Retrospective analysis of circulatory support with the Impella CP® device in patients with therapy refractory cardiogenic shock. Int J Cardiol. 2016; 219:200-3. DOI: 10.1016/j.ijcard.2016.06.023. View