Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis
During veno-arterial extracorporeal membrane oxygenation (VA-ECMO), the increase of left ventricular (LV) afterload can potentially increase the LV stress, exacerbate myocardial ischemia and delay recovery from cardiogenic shock (CS). Several strategies of LV unloading have been proposed. Systematic...
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| Format: | Article |
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MDPI AG
2020-04-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/4/1039 |
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| author | Mariusz Kowalewski Pietro Giorgio Malvindi Kamil Zieliński Gennaro Martucci Artur Słomka Piotr Suwalski Roberto Lorusso Paolo Meani Antonio Arcadipane Michele Pilato Giuseppe Maria Raffa |
| author_facet | Mariusz Kowalewski Pietro Giorgio Malvindi Kamil Zieliński Gennaro Martucci Artur Słomka Piotr Suwalski Roberto Lorusso Paolo Meani Antonio Arcadipane Michele Pilato Giuseppe Maria Raffa |
| author_sort | Mariusz Kowalewski |
| collection | DOAJ |
| description | During veno-arterial extracorporeal membrane oxygenation (VA-ECMO), the increase of left ventricular (LV) afterload can potentially increase the LV stress, exacerbate myocardial ischemia and delay recovery from cardiogenic shock (CS). Several strategies of LV unloading have been proposed. Systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement included adult patients from studies published between January 2000 and March 2019. The search was conducted through numerous databases. Overall, from 62 papers, 7581 patients were included, among whom 3337 (44.0%) received LV unloading concomitant to VA-ECMO. Overall, in-hospital mortality was 58.9% (4466/7581). A concomitant strategy of LV unloading as compared to ECMO alone was associated with 12% lower mortality risk (RR 0.88; 95% CI 0.82–0.93; <i>p</i> < 0.0001; <i>I</i><sup>2</sup> = 40%) and 35% higher probability of weaning from ECMO (RR 1.35; 95% CI 1.21–1.51; <i>p</i> < 0.00001; <i>I</i><sup>2</sup> = 38%). In an analysis stratified by setting, the highest mortality risk benefit was observed in case of acute myocardial infarction: RR 0.75; 95%CI 0.68–0.83; <i>p</i> < 0.0001; <i>I</i><sup>2</sup> = 0%. There were no apparent differences between two techniques in terms of complications. In heterogeneous populations of critically ill adults in CS and supported with VA-ECMO, the adjunct of LV unloading is associated with lower early mortality and higher rate of weaning. |
| first_indexed | 2024-03-10T20:37:13Z |
| format | Article |
| id | doaj.art-d6b6bceff5bb4d1b921da67bd1079ca9 |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T20:37:13Z |
| publishDate | 2020-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-d6b6bceff5bb4d1b921da67bd1079ca92023-11-19T20:55:53ZengMDPI AGJournal of Clinical Medicine2077-03832020-04-0194103910.3390/jcm9041039Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-AnalysisMariusz Kowalewski0Pietro Giorgio Malvindi1Kamil Zieliński2Gennaro Martucci3Artur Słomka4Piotr Suwalski5Roberto Lorusso6Paolo Meani7Antonio Arcadipane8Michele Pilato9Giuseppe Maria Raffa10Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02607 Warsaw, PolandWessex Cardiothoracic Centre, University Hospital Southampton, Southampton SO16 6YD, UKStudent Scientific Society, Warsaw Medical University, 02091 Warsaw, PolandAnesthesia and Intensive Care Department, IRCCS-ISMETT, 90127 Palermo, ItalyChair and Department of Pathophysiology, Nicolaus Copernicus University, Collegium Medicum in Bydgoszcz, 85067 Bydgoszcz, PolandClinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02607 Warsaw, PolandDepartment of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6229 Maastricht, The NetherlandsDepartment of Intensive Care Unit, Maastricht University Medical Centre (MUMC+), 6229 Maastricht, The NetherlandsAnesthesia and Intensive Care Department, IRCCS-ISMETT, 90127 Palermo, ItalyDepartment for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), 90127 Palermo, ItalyDepartment for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT (Instituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione), 90127 Palermo, ItalyDuring veno-arterial extracorporeal membrane oxygenation (VA-ECMO), the increase of left ventricular (LV) afterload can potentially increase the LV stress, exacerbate myocardial ischemia and delay recovery from cardiogenic shock (CS). Several strategies of LV unloading have been proposed. Systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement included adult patients from studies published between January 2000 and March 2019. The search was conducted through numerous databases. Overall, from 62 papers, 7581 patients were included, among whom 3337 (44.0%) received LV unloading concomitant to VA-ECMO. Overall, in-hospital mortality was 58.9% (4466/7581). A concomitant strategy of LV unloading as compared to ECMO alone was associated with 12% lower mortality risk (RR 0.88; 95% CI 0.82–0.93; <i>p</i> < 0.0001; <i>I</i><sup>2</sup> = 40%) and 35% higher probability of weaning from ECMO (RR 1.35; 95% CI 1.21–1.51; <i>p</i> < 0.00001; <i>I</i><sup>2</sup> = 38%). In an analysis stratified by setting, the highest mortality risk benefit was observed in case of acute myocardial infarction: RR 0.75; 95%CI 0.68–0.83; <i>p</i> < 0.0001; <i>I</i><sup>2</sup> = 0%. There were no apparent differences between two techniques in terms of complications. In heterogeneous populations of critically ill adults in CS and supported with VA-ECMO, the adjunct of LV unloading is associated with lower early mortality and higher rate of weaning.https://www.mdpi.com/2077-0383/9/4/1039cardiogenic shockextracorporeal membrane oxygenationextracorporeal life supportresuscitation |
| spellingShingle | Mariusz Kowalewski Pietro Giorgio Malvindi Kamil Zieliński Gennaro Martucci Artur Słomka Piotr Suwalski Roberto Lorusso Paolo Meani Antonio Arcadipane Michele Pilato Giuseppe Maria Raffa Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis Journal of Clinical Medicine cardiogenic shock extracorporeal membrane oxygenation extracorporeal life support resuscitation |
| title | Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis |
| title_full | Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis |
| title_fullStr | Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis |
| title_full_unstemmed | Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis |
| title_short | Left Ventricle Unloading with Veno-Arterial Extracorporeal Membrane Oxygenation for Cardiogenic Shock. Systematic Review and Meta-Analysis |
| title_sort | left ventricle unloading with veno arterial extracorporeal membrane oxygenation for cardiogenic shock systematic review and meta analysis |
| topic | cardiogenic shock extracorporeal membrane oxygenation extracorporeal life support resuscitation |
| url | https://www.mdpi.com/2077-0383/9/4/1039 |
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