Comparison of ECMO vs ECpella in Patients With Non-Post-Pericardiotomy Cardiogenic Shock: An Updated Meta-Analysis |
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| Affiliation: | 1. Division of Cardiology, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy;2. Division of Cardiology, A.O. Papardo, Messina, Italy;3. Division of Cardiology, Città della Scienza e della Salute, University of Turin, Turin, Italy;4. Department of Anesthesiology and Intensive Care, San Giovanni Bosco Hospital, ASL Città di Torino, Turin, Italy;5. Division of Cardiology, Sevigliano, ASL CN1, Italy;6. Cardiovascular Disease Unit, IRCCS Policlinic Hospital San Martino, Genova, Italy;7. Virginia Heart/Inova Heart and Vascular Institute, Falls Church, VA, USA;1. Division of Cardiology, Mercy-Health St Vincent Medical Center, Toledo, OH;2. Duke Clinical Research Institute, Durham, NC;3. Henry Ford Hospital, Detroit, MI;4. Tufts Medical Center, The CardioVascular Center, Boston, MA;5. Division of Cardiology, Department of Internal Medicine, St John Hospital and Medical Center, Detroit, MI;6. Abiomed Inc., Abiomed, Danvers, MA;1. Department of Cardiology, Harefield Hospital, Guys & St Thomas'' Foundation Trust, London, UK;2. National Heart and Lung Institute, Imperial College London, UK;3. Department of Cardiothoracic Surgery, Hospital Universitario La Princesa, Madrid, Spain |
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| Abstract: | IntroductionThe impact of Impella and ECMO (ECPELLA) in cardiogenic shock (CS) remains to be defined. The aim of this meta-analysis is to evaluate the benefit of ECPELLA compared to VA-ECMO in patients with non post-pericardiotomy CS.MethodsAll studies reporting short term outcomes of ECpella or VA ECMO in non post-pericardiotomy CS were included. The primary endpoint was 30-day mortality. Vascular and bleeding complications and LVAD implantation/heart transplant within 30-days were assessed as secondary outcomes.ResultsOf 407 studies identified, 13 observational studies (13,682 patients, 13,270 with ECMO and 412 with ECpella) were included in this analysis. 30-day mortality was 55.8% (51.6–59.9) in the VA-ECMO group and 58.3% (53.5–63.0) in the ECpella group. At meta-regression analysis the implantation of IABP did not affect mortality in the ECMO group. The rate of major bleeding in patients on VA-ECMO and ECpella support were 21.3% (16.9–26.5) and 33.1% (25.9–41.2) respectively, while the rates of the composite outcome of LVAD implantation and heart transplantation within 30-days in patients on VA-ECMO and ECpella support were 14.4% (9.0–22.2) and 10.8%. When directly compared in 3 studies, ECpella showed a positive effect on 30-day mortality compared to ECMO (OR: 1.81: 1.039–3.159).ConclusionOur data suggest that ECpella may reduce 30-day mortality and increase left ventricle recovery, despite increased of bleeding rates. |
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