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Impella to unload the left ventricle in patients undergoing venoarterial extracorporeal membrane oxygenation for cardiogenic shock: A systematic review and meta‐analysis
Author(s) -
Grajeda Silvestri Edwin R.,
Pino Jesus E.,
Donath Elie,
Torres Pedro,
Chait Robert,
Ghumman Waqas
Publication year - 2020
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14560
Subject(s) - medicine , impella , cardiogenic shock , extracorporeal membrane oxygenation , meta analysis , ventricle , confidence interval , cochrane library , cardiology , relative risk , myocardial infarction
Background and Aim Impella is frequently used to unload the left ventricle in patients with cardiogenic shock on venoarterial extracorporeal membrane oxygenation (VA‐ECMO). There is limited data regarding the use of this strategy. This study aims to evaluate the safety and efficacy of the said strategy. Methods A systematic search for studies comparing Impella plus VA‐ECMO (ECVAD) vs VA‐ECMO alone was performed using Pubmed, Cochrane Library, and Scopus. Studies meeting inclusion criteria were then used to perform a meta‐analysis. Results Three studies involving 448 patients were included in the final analysis. In total, 117 (26%) patients were female, mean age was 57 years. VA‐ECMO was placed in 355 out of 448 (79%) patients, while ECVAD was placed in 93 out of 448 (21%). Death occurred in 49 out of 93 (52.6%) patients on ECVAD and 226 out of 355 (63.6%) on ECMO, relative risk (RR): 0.76, confidence interval (CI), 95% (0.62‐0.94) P = .01. Hemolysis was present in 46 (49.4%) patients in the ECVAD vs 67 (18%) in the ECMO group, RR: 2.64, CI, 95% (1.97–3.55) P < .01. Bleeding was present in 42 (45.2.%) patients in the ECVAD group and 135 (38%) in the ECMO group, RR: 1.25, CI, 95% (0.95‐1.63) P = .11. CVVHD was used on 31 (33.3%) patients in the ECVAD group while 89 (25%) in the ECMO group, RR 1.35, CI, 95% (0.95‐1.91) P = .10. Conclusion This study suggests that the use of Impella as an unloading strategy in patients with VA‐ECMO decreased mortality, increased rate of hemolysis, neutral bleeding risk, and similar rates of acute kidney injury requiring CVVHD.