主动脉内球囊泵与静脉-动脉体外膜氧合对急性心肌梗死合并心源性休克的影响：一项荟萃分析。

IF 1.1 4区医学 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS

Perfusion-Uk Pub Date : 2024-10-01 Epub Date: 2023-07-27 DOI:10.1177/02676591231189941

Yidan Liu, Min Zeng, Yifang Zhou, Wenjie Qiu, Ruixiang Zeng, Yuanshen Zhou

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引用次数: 0

摘要

背景：文献中对急性心肌梗死合并心源性休克（AMICS）患者同时使用主动脉内球囊反搏泵（IABP）和静脉-动脉体外膜肺氧合（VA-ECMO）干预的有效性存在争议。本研究旨在比较急性心肌梗死合并心源性休克（AMICS）病例中 VA-ECMO 的短期死亡率：我们进行了文献综述，并比较了以下治疗组 AMICS 患者的主要和次要终点：(1）VA-ECMO 加 IABP 与单用 IABP；（2）VA-ECMO 加 IABP 与单用 VA-ECMO。主要终点是院内全因死亡率；次要终点是30天死亡率、VA-ECMO断流和血管并发症：结果：3580 名患者（76.4%）在使用 VA-ECMO 的同时使用了 IABP，而仅使用 IABP 和仅使用 VA-ECMO 的患者分别占 1.7% 和 21.9%。我们发现，使用 VA-ECMO 加 IABP 与仅使用 VA-ECMO 相比，患者的院内死亡率明显降低（比值比 (OR) = 0.52；95% 置信区间 (CI) = 0.21-1.31；I 平方统计（I2 = 30%））或仅使用 IABP（OR = 0.20；95% CI = 0.08-0.55；I2 = 0%）。此外，使用 VA-ECMO 加 IABP 与单独使用 VA-ECMO（OR = 0.31；95% CI = 0.25-0.40；I2 = 0%）或单独使用 IABP（OR = 0.24；95% CI = 0.11-0.50；I2 = 0%）相比，30 天死亡率明显降低。在VA-ECMO加IABP治疗与单独使用VA-ECMO治疗的患者中，观察到VA-ECMO的断奶率存在明显差异（OR = 1.91；95% CI = 1.09-3.33；I2 = 0%）：结论：与单纯VA-ECMO或单纯IABP相比，接受VA-ECMO加IABP治疗的AMICS患者的院内死亡率和30天死亡率明显降低。VA-ECMO同时使用IABP可增加从VA-ECMO断流的患者比例，显著降低院内死亡率，而不会增加并发症。

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Effect of intra-aortic balloon pump with veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock: A meta-analysis.

Background: The effectiveness of a concomitant intra-aortic balloon pump (IABP) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) intervention in acute myocardial infarction with cardiogenic shock (AMICS) patients is contested in the literature. This study sought to compare short-term mortality weaning rate from VA-ECMOin AMICS cases.

Methods: We conducted a literature review and compared the primary and secondary endpoints in the following treatment groups of AMICS patients: (1) VA-ECMO plus IABP vs. IABP alone and (2) VA-ECMO plus IABP vs. VA-ECMO alone. The primary endpoint was in-hospital all-cause mortality; while 30-days mortality, weaning from VA-ECMO, and vascular complications comprised secondary endpoints.

Results: VA-ECMO concomitant with IABP was administered to 3,580 (76.4%) patients, while IABP alone and VA-ECMO alone treatments accounted for 1.7% and 21.9% of the patients, respectively. We found that in-hospital mortality was significantly lower in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (odds ratio (OR) = 0.52; 95% Confidence Interval (CI) = 0.21-1.31; I-squared statistic (I² = 30%) or IABP alone (OR = 0.20; 95% CI = 0.08-0.55; I² = 0%). Additionally, 30-days mortality was significantly lower in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (OR = 0.31; 95% CI = 0.25-0.40; I² = 0%) or IABP alone (OR = 0.24; 95% CI = 0.11-0.50; I² = 0%). A significant difference was observed in weaning from VA-ECMO in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (OR = 1.91; 95% CI = 1.09-3.33; I² = 0%).

Conclusion: In-hospital and 30-days mortality were significantly lower in AMICS patients treated with VA-ECMO plus IABP vs. VA-ECMO alone or IABP alone. VA-ECMO with concomitant IABP could increase the proportion of patients weaned from VA-ECMO, significantly reducing in-hospital mortality, without increasing complications.

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来源期刊

Perfusion-Uk 医学-外周血管病

CiteScore

3.00

自引率

8.30%

发文量

203

审稿时长

6-12 weeks

期刊介绍： Perfusion is an ISI-ranked, peer-reviewed scholarly journal, which provides current information on all aspects of perfusion, oxygenation and biocompatibility and their use in modern cardiac surgery. The journal is at the forefront of international research and development and presents an appropriately multidisciplinary approach to perfusion science.