Unveiling Baseline Clinical Divergence in VA ECMO vs. ECPELLA: Tailoring Treatment for Distinct Patient Profiles. A Systematic Review and Meta-analysis

IF 2.3 4区医学 Q2 ANESTHESIOLOGY

Journal of cardiothoracic and vascular anesthesia Pub Date : 2025-03-01 DOI:10.1053/j.jvca.2024.11.033

Andrea Montisci MD , Serena Ambrosi MD , Massimo Baudo MD , Rosaria Muratore MD , Giuseppe Cuttone MD , Nicoletta D'Ettore MD , Federico Pappalardo MD

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Abstract

Objectives

The benefit of combining multiple mechanical circulatory support (MCS) systems in patients with cardiogenic shock (CS) is debated. This review examines patient characteristics across studies to identify differences and assesses if patients with a higher-risk clinical profile receive Impella unloading.

Design

A systematic review and meta-analysis was conducted to examine if there were significant differences in baseline clinical parameters among patients receiving MCS in addition to venoarterial extracorporeal membrane oxygenation (VA ECMO).

Setting

A total of nine retrospective, three prospective, and two randomized controlled trials were included in this analysis.

Participants

The sample sizes ranged from 34 to 1,678 patients.

Interventions

The outcomes were assessments of differences in baseline clinical characteristics and comorbidities among patients that received VA ECMO alone or VA ECMO with intra-aortic balloon pump (IABP) versus ECPella.

Measurements and Main Results

ECPella patients showed a higher prevalence of coronary artery disease (65.0% v 34.6%, p < 0.0001), cardiac arrest before MCS implantation (63.1% v 52.7%, p < 0.0001), and ischemic CS (53.1% v 42.6%, p < 0.0001) compared with patients with VA ECMO alone. The comparison between ECPella and VA ECMO + IABP patients showed a higher prevalence of acute myocardial infarction-CS (53.1% v 39.0%, p < 0.0001), preimplantation cardiac arrest (63% v 49.3%, p < 0.0001), and extracorporeal cardiopulmonary resuscitation (25.8% v 20.0%, p = 0.0015). The inclusion of the two randomized controlled trials in the VA ECMO group increased the prevalence of comorbidities compared with the ECPella group.

Conclusions

Patients who received a combination of MCS and VA ECMO have a greater prevalence of comorbidities.

Abstract Image

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揭示VA ECMO与ECPELLA的基线临床差异：针对不同患者的定制治疗。系统回顾和荟萃分析。

目的：对心源性休克（CS）患者联合使用多种机械循环支持（MCS）系统的益处进行了讨论。本综述检查了不同研究的患者特征，以确定差异，并评估是否有较高临床风险的患者接受了Impella卸载。设计：进行系统回顾和荟萃分析，以检查接受MCS和静脉动脉体外膜氧合（VA ECMO）的患者的基线临床参数是否存在显著差异。背景：本分析共纳入9项回顾性试验、3项前瞻性试验和2项随机对照试验。参与者：样本量从34例到1678例不等。干预措施：结果是评估单独接受VA ECMO或VA ECMO联合主动脉内球囊泵（IABP）与ECPella的患者的基线临床特征和合并症的差异。测量结果和主要结果：与单独使用VA ECMO的患者相比，ECPella患者冠状动脉疾病（65.0% vs 34.6%, p < 0.0001）、MCS植入前心脏骤停（63.1% vs 52.7%, p < 0.0001）和缺血性CS （53.1% vs 42.6%, p < 0.0001）的患病率更高。ECPella与VA ECMO + IABP患者的比较显示，急性心肌梗死- cs （53.1% vs 39.0%, p < 0.0001）、着床前心脏骤停（63% vs 49.3%, p < 0.0001）和体外心肺复苏（25.8% vs 20.0%, p = 0.0015）的患病率更高。与ECPella组相比，在VA ECMO组纳入两项随机对照试验增加了合并症的发生率。结论：接受MCS和VA联合ECMO的患者有更大的合并症患病率。

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

Journal of cardiothoracic and vascular anesthesia 医学-呼吸系统

CiteScore

4.80

自引率

17.90%

发文量

606

审稿时长

37 days

期刊介绍： The Journal of Cardiothoracic and Vascular Anesthesia is primarily aimed at anesthesiologists who deal with patients undergoing cardiac, thoracic or vascular surgical procedures. JCVA features a multidisciplinary approach, with contributions from cardiac, vascular and thoracic surgeons, cardiologists, and other related specialists. Emphasis is placed on rapid publication of clinically relevant material.