Outcomes of VA-ECMO with and without Left Centricular (LV) Decompression Using Intra-Aortic Balloon Pumping (IABP) versus Other LV Decompression Techniques: A Systematic Review and Meta-Analysis
Pan Pan, Peng Yan, Dawei Liu, Xiaoting Wang, Xiang Zhou, Yun Long, Kun Xiao, Weiguo Zhao, Lixin Xie, Longxiang Su
Department of Critical Care Medicine, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China (mainland)
Med Sci Monit 2020; 26:e924009
Available online: 2020-06-03
Left ventricular decompression is the primary method for solving VA-ECMO-induced LV afterload increase, but the effect of specific methods on patient outcomes and complications is unknown.
MATERIAL AND METHODS: We searched for all published reports conducted in patients undergoing ECMO combined with LVD. Statistical analyses were performed using Stata 12.0.
RESULTS: The results showed that the risk of death with ECMO combined with LVD was 29% lower than that with ECMO alone (OR=0.71, 95% CI: 0.56-0.89, I²=59.5%, P<0.001). Although the risk of death with ECMO combined other LV decompression techniques was higher than that with ECMO combined with IABP, the difference was not statistically significant (OR=1.27, 95% CI: 0.86-1.87, I²=44.0%, P=0.057). In addition, the ORs values of hemorrhage, stroke/acute episodes, lower-limb ischemia, and hemolysis for ECMO combined with LVD were 0.69 (0.66-0.71), 0.82 (0.78-0.89), 0.71 (0.30-1.66), and 0.48 (0.16-1.39), respectively. The risk of complications, such as stroke/TIA, limb ischemia, and hemolysis, of ECMO combined with IABP was lower than that of ECMO combined other LV decompression techniques, and the risk of bleeding was higher for ECMO combined with IABP.
CONCLUSIONS: ECMO combined with LVD is more beneficial than using ECMO alone and helps to lower patient mortality.
Keywords: Extracorporeal Membrane Oxygenation, Intra-Aortic Balloon Pumping, Mortality, Postoperative Complications, Ventricular Outflow Obstruction