医学
叶轮
体外膜肺氧合
心源性休克
溶血
肾脏替代疗法
内科学
心脏病学
临床终点
卫生棉条
经皮
心室辅助装置
相对风险
急性肾损伤
外科
心力衰竭
心肌梗塞
置信区间
随机对照试验
免疫学
作者
Luigi Cappannoli,Mattía Galli,Andrea Zito,Attilio Restivo,Giuseppe Princi,Renzo Laborante,Rocco Vergallo,Enrico Romagnoli,Antonio Maria Leone,Cristina Aurigemma,Massimo Massetti,Tommaso Sanna,Carlo Trani,Francesco Burzotta,Gianluigi Savarese,Filippo Crea,Domenico D’Amario
出处
期刊:European Heart Journal - Quality of Care and Clinical Outcomes
[Oxford University Press]
日期:2022-11-12
被引量:8
标识
DOI:10.1093/ehjqcco/qcac076
摘要
The use of venoarterial extracorporeal membrane oxygenation (VA-ECMO) for the treatment of cardiogenic shock (CS) may result in left ventricle overload and distension. Percutaneous microaxial flow pump Impella in addition to VA-ECMO (ECPELLA) is an emerging option to overcome these collateral effects. Aim of this study is to assess whether the addition of Impella to VA-ECMO is an effective and safe unloading strategy.We performed a systematic literature review of studies comparing ECPELLA vs. ECMO alone in patients with CS. The primary endpoint was early mortality (in-hospital or 30-day mortality). The secondary endpoints were bleeding, need for kidney replacement therapy, haemolysis, infections, and limb ischaemia. A total of 3469 potentially relevant articles were screened and eight retrospective studies including 11.137 patients were selected. There was no significant difference in early mortality (Risk Ratio, RR 0.90, 95% CI 0.78-1.03) between ECPELLA and ECMO. Nevertheless, there was a borderline significant reduction in early mortality with ECPELLA (RR 0.74, 95% CI 0.55-1.00) at sensitivity analysis selectively including studies reporting propensity matched analysis. ECPELLA was associated with increased bleeding (RR 1.45, 95% CI 1.20-1.75), need for kidney replacement therapy (RR 1.54, 95% CI 1.19-1.99), haemolysis (RR 1.71, 95% CI 1.41-2.07) and limb ischaemia (RR 1.43, 95% CI 1.17-1.75) and with a non-significant increase in severe infections (RR 1.26, 95% CI 0.84-1.89), compared with ECMO alone.Among patients with cardiogenic shock, ECPELLA is associated with increased complications compared with ECMO. Whether reducing ventricular overload with Impella among patients treated with ECMO reduces early mortality needs to be confirmed by further investigations.
科研通智能强力驱动
Strongly Powered by AbleSci AI