Efficacy of venoarterial extracorporeal membrane oxygenation with and without intra-aortic balloon pump in adult cardiogenic shock

Haiwang Wang; Chuanlong Li; Duo Li; Yuansen Chen; Wenli Li; Yanqing Liu; Yongnan Li; Haojun Fan; Shike Hou

doi:10.3389/fcvm.2024.1431875

Efficacy of venoarterial extracorporeal membrane oxygenation with and without intra-aortic balloon pump in adult cardiogenic shock

Front Cardiovasc Med. 2024 Sep 6:11:1431875. doi: 10.3389/fcvm.2024.1431875. eCollection 2024.

Authors

Haiwang Wang¹, Chuanlong Li², Duo Li¹, Yuansen Chen¹, Wenli Li¹, Yanqing Liu¹, Yongnan Li³, Haojun Fan¹, Shike Hou¹

Affiliations

¹ Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.
² Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China.
³ Laboratory of Extracorporeal Life Support, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China.

Abstract

Introduction: Intra-aortic balloon pump (IABP) is sometimes coupled with Venoarterial extracorporeal membrane oxygenation (VA-ECMO) to treat patients with cardiogenic shock. In this study, we attempted to evaluate the association of the IABP approach on survival and vascular complication rates in adults with cardiogenic shock undergoing VA-ECMO.

Methods: We performed a systematic search of original studies on VA-ECMO with and without IABP in PubMed, EMBASE, and the Cochrane Library.

Results: A total of 42 studies with 8,759 patients were included. The pooled in-hospital deaths of patients on VA-ECMO with and without IABP were 2,962/4,807 (61.61%) versus 2,666/3,952 (67.45%). VA-ECMO with IABP presents lower in-hospital mortality (risk ratio, 0.88; 95% CI, 0.86-0.91; P < 0.00001). In addition, IABP was associated with lower in-hospital mortality of patients with postcardiotomy cardiogenic shock and ischaemic heart disease. (risk ratio, 0.93; 95% CI, 0.87-0.98; P = 0.01; risk ratio, 0.85; 95% CI, 0.82-0.89; P < 0.00001). There was no significant difference in in-hospital morbidity in neurological, gastrointestinal, limb-related, bleeding, and infection complications between patients on VA-ECMO with and without IABP.

Discussion: In these observational studies, concomitant use of IABP and VA-ECMO in adult patients with cardiogenic shock was associated with reduced in-hospital mortality.

Systematic review registration: PROSPERO [CRD42017069259].

Keywords: cardiogenic shock; complications; intra-aortic balloon pump; meta-analysis; survival; venoarterial extracorporeal membrane oxygenation.

Publication types

Systematic Review

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This research was supported by the Wenzhou Science Bureau Major Scientific and Technological Innovation project (ZS2022007). Research and Development of Medical Emergency and Critical Care Treatment and Monitoring Equipment - Research and Development of Intelligent Robot for Rapid Interventional Hemostasis (ZY2023017).