Efficacy and Safety of Extracorporeal Membrane Oxygenation for Cardiogenic Shock Complicating Myocardial Infarction: a Systematic Review and Meta-analysis

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2024 Jul 16

PMID 39014315

Authors

Ahmed Saad Elsaeidy

Amira Mohamed Taha

Mohamed Abuelazm

Youssef Soliman

Mohamed Ahmed Ali

Abdullah K Alassiri

Hosam Shaikhkhalil

Basel Abdelazeem

Affiliations

Soon will be listed here.

Abstract

Background: Extracorporeal membrane oxygenation (ECMO) has been presented as a potential therapeutic option for patients with cardiogenic shock complicating myocardial infarction (CS-MI). We aimed to investigate the efficacy and safety of ECMO in CS-MI.

Methods: A systematic review and meta-analysis synthesizing evidence from randomized controlled trials obtained from PubMed, Embase, Cochrane, Scopus, and Web of Science until September 2023. We used the random-effects model to report dichotomous outcomes using risk ratio and continuous outcomes using mean difference with a 95% confidence interval. Finally, we implemented a trial sequential analysis to evaluate the reliability of our results.

Results: We included four trials with 611 patients. No significant difference was observed between ECMO and standard care groups in 30-day mortality with pooled RR of 0.96 (95% CI: 0.81-1.13, p = 0.60), acute kidney injury (RR: 0.65, 95% CI: 0.41-1.03, p = 0.07), stroke (RR: 1.16, 95% CI: 0.38-3.57, p = 0.80), sepsis (RR: 1.06, 95% CI: 0.77-1.47, p = 0.71), pneumonia (RR: 0.99, 95% CI: 0.58-1.68, p = 0.96), and 30-day reinfarction (RR: 0.95, 95% CI: 0.25-3.60, p = 0.94). However, the ECMO group had higher bleeding events (RR: 2.07, 95% CI: 1.44-2.97, p < 0.0001).

Conclusion: ECMO did not improve clinical outcomes compared to the standard of care in patients with CS-MI but increased the bleeding risk.

Citing Articles

The Efficacy and Safety of Levosimendan in Patients with Advanced Heart Failure: An Updated Meta-Analysis of Randomized Controlled Trials.

Elsaeidy A, Abuelazm M, Ghaly R, Soliman Y, Amin A, El-Gohary M Am J Cardiovasc Drugs. 2024; 24(6):775-790.

PMID: 39261444 PMC: 11525400. DOI: 10.1007/s40256-024-00675-z.

References

Rob D, Belohlavek J . The mechanical support of cardiogenic shock. Curr Opin Crit Care. 2021; 27(4):440-446. DOI: 10.1097/MCC.0000000000000837. View

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

Zangrillo A, Landoni G, Biondi-Zoccai G, Greco M, Greco T, Frati G . A meta-analysis of complications and mortality of extracorporeal membrane oxygenation. Crit Care Resusc. 2013; 15(3):172-8. View

Zeymer U, Freund A, Hochadel M, Ostadal P, Belohlavek J, Rokyta R . Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials. Lancet. 2023; 402(10410):1338-1346. DOI: 10.1016/S0140-6736(23)01607-0. View

Omar H, Mirsaeidi M, Shumac J, Enten G, Mangar D, Camporesi E . Incidence and predictors of ischemic cerebrovascular stroke among patients on extracorporeal membrane oxygenation support. J Crit Care. 2015; 32:48-51. DOI: 10.1016/j.jcrc.2015.11.009. View

Thiele H, Ohman E, de Waha-Thiele S, Zeymer U, Desch S . Management of cardiogenic shock complicating myocardial infarction: an update 2019. Eur Heart J. 2019; 40(32):2671-2683. DOI: 10.1093/eurheartj/ehz363. View

Xie A, Phan K, Tsai Y, Yan T, Forrest P . Venoarterial extracorporeal membrane oxygenation for cardiogenic shock and cardiac arrest: a meta-analysis. J Cardiothorac Vasc Anesth. 2014; 29(3):637-45. DOI: 10.1053/j.jvca.2014.09.005. View

Zeymer U, Bueno H, Granger C, Hochman J, Huber K, Lettino M . Acute Cardiovascular Care Association position statement for the diagnosis and treatment of patients with acute myocardial infarction complicated by cardiogenic shock: A document of the Acute Cardiovascular Care Association of the European Society.... Eur Heart J Acute Cardiovasc Care. 2020; 9(2):183-197. DOI: 10.1177/2048872619894254. View

Ouweneel D, Schotborgh J, Limpens J, Sjauw K, Engstrom A, Lagrand W . Extracorporeal life support during cardiac arrest and cardiogenic shock: a systematic review and meta-analysis. Intensive Care Med. 2016; 42(12):1922-1934. PMC: 5106498. DOI: 10.1007/s00134-016-4536-8. View

10.

McDonagh T, Metra M, Adamo M, Gardner R, Baumbach A, Bohm M . 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. Eur Heart J. 2021; 42(36):3599-3726. DOI: 10.1093/eurheartj/ehab368. View

11.

Brok J, Thorlund K, Gluud C, Wetterslev J . Trial sequential analysis reveals insufficient information size and potentially false positive results in many meta-analyses. J Clin Epidemiol. 2008; 61(8):763-9. DOI: 10.1016/j.jclinepi.2007.10.007. View

12.

Wetterslev J, Jakobsen J, Gluud C . Trial Sequential Analysis in systematic reviews with meta-analysis. BMC Med Res Methodol. 2017; 17(1):39. PMC: 5397700. DOI: 10.1186/s12874-017-0315-7. View

13.

Zavalichi M, Nistor I, Nedelcu A, Zavalichi S, Georgescu C, Statescu C . Extracorporeal Membrane Oxygenation in Cardiogenic Shock due to Acute Myocardial Infarction: A Systematic Review. Biomed Res Int. 2020; 2020:6126534. PMC: 7193268. DOI: 10.1155/2020/6126534. View

14.

Guyatt G, Oxman A, Vist G, Kunz R, Falck-Ytter Y, Alonso-Coello P . GRADE: an emerging consensus on rating quality of evidence and strength of recommendations. BMJ. 2008; 336(7650):924-6. PMC: 2335261. DOI: 10.1136/bmj.39489.470347.AD. View

15.

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

16.

Fang D, Yu D, Xu J, Ma W, Zhong Y, Chen H . Effects of intra-aortic balloon pump on in-hospital outcomes and 1-year mortality in patients with acute myocardial infarction complicated by cardiogenic shock. BMC Cardiovasc Disord. 2023; 23(1):425. PMC: 10466728. DOI: 10.1186/s12872-023-03465-8. View

17.

Thiele H, Zeymer U, Akin I, Behnes M, Rassaf T, Mahabadi A . Extracorporeal Life Support in Infarct-Related Cardiogenic Shock. N Engl J Med. 2023; 389(14):1286-1297. DOI: 10.1056/NEJMoa2307227. View

18.

Cumpston M, Li T, Page M, Chandler J, Welch V, Higgins J . Updated guidance for trusted systematic reviews: a new edition of the Cochrane Handbook for Systematic Reviews of Interventions. Cochrane Database Syst Rev. 2019; 10:ED000142. PMC: 10284251. DOI: 10.1002/14651858.ED000142. View

19.

Lackermair K, Brunner S, Orban M, Peterss S, Orban M, Theiss H . Outcome of patients treated with extracorporeal life support in cardiogenic shock complicating acute myocardial infarction: 1-year result from the ECLS-Shock study. Clin Res Cardiol. 2020; 110(9):1412-1420. DOI: 10.1007/s00392-020-01778-8. View

20.

Sterne J, Savovic J, Page M, Elbers R, Blencowe N, Boutron I . RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ. 2019; 366:l4898. DOI: 10.1136/bmj.l4898. View