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Mechanical left ventricular unloading in cardiogenic shock treated with venoarterial extracorporeal membrane oxygenation: a systematic review and meta-analysis.
Kotani, Yuki; Yamamoto, Taihei; Koroki, Takatoshi; Yaguchi, Takahiko; Nakamura, Yuta; Tonai, Mayuko; Karumai, Toshiyuki; Nardelli, Pasquale; Landoni, Giovanni; Hayashi, Yoshiro.
Afiliación
  • Yamamoto T; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
  • Koroki T; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
  • Yaguchi T; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
  • Nakamura Y; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
  • Tonai M; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
  • Karumai T; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
  • Nardelli P; Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Hayashi Y; Department of Intensive Care Medicine, Kameda Medical Center, Kamogawa, Japan.
Shock ; 2024 Aug 28.
Article en En | MEDLINE | ID: mdl-39194234
ABSTRACT

OBJECTIVE:

To evaluate if mechanical left ventricular unloading could reduce mortality in patients with cardiogenic shock undergoing venoarterial extracorporeal membrane oxygenation (VA-ECMO).

METHODS:

We searched MEDLINE, Embase, and the Cochrane Library for randomized controlled trials and propensity score-matched studies published until December 20, 2023. The primary outcome was mortality at the longest follow-up. We used a Mantel-Haenszel random effects meta-analysis and reported the pooled results with a risk ratio (RR) and 95% confidence interval (CI). The review protocol was registered on PROSPERO International prospective register of systematic review (CRD42024498665).

RESULTS:

We identified two randomized controlled trials and eleven propensity score-matched studies, totaling 9858 patients. Mechanical left ventricular unloading was significantly associated with reduced mortality at the longest follow-up (RR, 0.89; 95% CI, 0.84-0.94; P = 0.0001; moderate certainty of evidence), which was confirmed in studies using intraaortic ballon pump (IABP). Benefits of mechanical unloading were also observed in terms of successful VA-ECMO weaning (RR, 1.15; 95% CI, 1.02-1.29; P = 0.02; low certainty of evidence) and favorable neurological outcome (two studies; RR, 2.45; 95% CI, 1.62-3.69; P < 0.0001; low certainty of evidence), although we observed an increased incidence of major bleeding (RR, 1.27; 95% CI, 1.02-1.59; P = 0.03; low certainty of evidence) and hemolysis (RR, 1.49; 95% CI, 1.10-2.02; P = 0.01; moderate certainty of evidence).

CONCLUSIONS:

Among adult patients with cardiogenic shock treated with VA-ECMO, mechanical left ventricular unloading was associated with reduced mortality, which was confirmed in studies using IABP as an unloading device.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Shock Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Shock Asunto de la revista: ANGIOLOGIA / CARDIOLOGIA Año: 2024 Tipo del documento: Article Pais de publicación: Estados Unidos