Left Ventricular Unloading With Impella Versus IABP in Patients With VA-ECMO: A Systematic Review and Meta-Analysis.
The American journal of cardiology
Venoarterial extracorporeal membrane oxygenation (VA-ECMO) use for circulatory support in cardiogenic shock results in increased left ventricular (LV) afterload. The use of concomitant Impella or intra-aortic balloon pump (IABP) have been proposed as adjunct devices for LV unloading. The authors sought to compare head-to-head efficacy and safety outcomes between the 2 LV unloading strategies. We conducted a search of Medline, EMBASE, and Cochrane databases to identify studies comparing the use of Impella to IABP in patients on VA-ECMO. The primary outcome of interest was in-hospital mortality. The secondary outcomes included transition to durable LV assist devices/cardiac transplantation, stroke, limb ischemia, need for continuous renal replacement therapy, major bleeding, and hemolysis. Pooled risk ratios (RRs) with 95% confidence interval and heterogeneity statistic I
Gandhi KD, Moras EC, Niroula S, Lopez PD, Aggarwal D, Bhatia K, et al Left ventricular unloading with impella versus IABP in Patients with VA-ECMO: A systematic review and meta-analysis. Am J Cardiol. 2023 Oct 7;208:53-59. doi: 10.1016/j.amjcard.2023.09.023. Epub ahead of print. PMID: 37812867.