Background. Cardiogenic shock is associated with high mortality, despite new strategies for reperfusion therapy. Short-term circulatory support devices may provide adequate support for appropriate myocardial and organ perfusion. Objectives. This review is aimed at evaluating the impact on survival when using venoarterial extracorporeal membrane oxygenation (V-A ECMO) in patients with cardiogenic shock due to acute myocardial infarction (AMI). Methods. We performed a systematic review that included studies using V-A ECMO in patients with cardiogenic shock. Time on ECMO, side effects, and the number of deceased patients, transplanted or upgraded to durable assist devices were analysed. Literature search was done using PubMed/MEDLINE (inception (1969) to January 10, 2019), ProQuest (inception (January 14, 1988) to January 10, 2019), and clinicaltrials.gov (inception (September 12, 2005) to January 10, 2019), by 2 authors. This protocol is registered with PROSPERO (no. CRD42019123982). Results. We included 9 studies with a total of 1,998 adult patients receiving V-A ECMO for AMI-induced cardiogenic shock. Survival rate varied from 30.0% to 79.2% at discharge and from 23.2% to 36.1% at 12 months. Time on ECMO varied between 1.96 and 6.0 days. Reported serious adverse events were gastrointestinal bleeding (3.6%) and peripheral complications (8.5%). Conclusion. The use of V-A ECMO among patients with AMI-induced cardiogenic shock may provide survival benefits. However, V-A ECMO treatment effects are inconclusive because of limitations in cohort design and reporting.
IntroductionCOVID-19 pandemic represents a major worldwide challenge, with a great impact on health systems and economic mechanisms. SARS-CoV-2, the pathogen agent that generates COVID-19, creates a wide variety of organ dysfunctions, from acute respiratory distress syndrome (ARDS) to acute myocardial infarction or pulmonary embolism. Mechanical circulatory support devices such as Extracorporeal Membrane Circulatory Oxygenation (ECMO) have shown their efficacy in maintaining organs perfusion in respiratory and cardiac impairments. With this review, we aimed to assess the impact of ECMO use in COVID-19 patients with ARDS.Material and methodsWe performed a systematic review to find the studies using ECMO in COVID-19. Comorbidities, side effects, and survival rate to discharge were analysed. The literature search was done using PubMed/MEDLINE, Web of Science, Embase (Elsevier), the Cochrane Central Register of Controlled Trials (Wiley) and clinicaltrials.gov databases (inception (December 2019) to October 16, 2021), by 2 authors.ResultsWe included 33 studies from 10 countries with a total of 4.760 patients receiving ECMO for COVID-19. Survival rate varied from 9% to 90,6% at discharge. The most serious adverse events were acute kidney injury (up to 87%), major bleeding (up to 92,1%), strokes or cerebral hemorrhage (up to 34%). Other complications such as pulmonary embolism, peripheral bleeding, or sepsis had a major impact on survival rates.ConclusionsECMO in COVID-19 patients may be a useful rescue therapy instrument, but due to the great variability of studies and still unknown mechanisms and effects of the SARS-CoV-2, further studies are need to be done.
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