Different strategies in left ventricle unloading during venoarterial extracorporeal membrane oxygenation: A network meta-analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2024-09-04 DOI:10.1016/j.ijcha.2024.101506

Han Zhang , Tianlong Wang , Jing Wang, Gang Liu, Shujie Yan, Yuan Teng, Jian Wang, Bingyang Ji

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引用次数: 0

Abstract

Background

Left ventricular (LV) overload is a frequent complication during VA-ECMO associated with poor outcomes. Many strategies of LV unloading have been documented but lack of evidence shows which is better. We conducted a network meta-analysis to compare different LV unloading strategies.

Methods

We searched databases for all published studies on LV unloading strategies during VA-ECMO. The pre-defined primary outcome was all-cause mortality.

Results

45 observational studies (34235 patients) were included. The Surface Under the Cumulative Ranking values (SUCRA) demonstrated that compared to no unloading strategy (15.4 %), IABP (73.8 %), pLVAD (60.8 %), atrial septostomy (51.2 %), catheter venting (48.8 %) were all associated with decreased all-cause mortality, in which IABP and pLVAD existed statistical significance. For secondary outcomes, no unloading group had the shortest VA-ECMO duration, ICU and hospital length of stay, and the lower risk of complications compared with unloading strategies. IABP was associated with reducing VA-ECMO duration, ICU and hospital length of stay, and the risk of complications (except for hemolysis as the second best) compared with other unloading strategies.

Conclusions

LV unloading strategies during VA-ECMO were associated with improved survival compared to no unloading, but the tendency to increase the risk of various complications deserves more consideration.

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静脉体外膜氧合过程中左心室卸载的不同策略：网络荟萃分析

背景左心室（LV）负荷过重是 VA-ECMO 期间经常出现的并发症，与不良预后有关。目前已有多种左心室减压策略，但没有证据表明哪种策略更好。我们进行了一项网络荟萃分析，以比较不同的左心室减压策略。方法我们在数据库中搜索了所有已发表的关于VA-ECMO期间左心室减压策略的研究。结果共纳入45项观察性研究（34235例患者）。累积排名表面值（Surface Under the Cumulative Ranking values，SUCRA）显示，与无减压策略（15.4%）相比，IABP（73.8%）、pLVAD（60.8%）、心房间隔造口术（51.2%）和导管通气（48.8%）均与全因死亡率下降相关，其中IABP和pLVAD具有统计学意义。在次要结果方面，与减压策略相比，无减压组的VA-ECMO持续时间、重症监护室和住院时间最短，并发症风险较低。与其他卸载策略相比，IABP可缩短VA-ECMO持续时间、缩短ICU和住院时间、降低并发症风险（溶血风险次之）。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.