Effects of Additional Intra-aortic Balloon Counter-Pulsation Therapy to Cardiogenic Shock Patients Supported by Extra-corporeal Membranous Oxygenation

Abstract

Extra-corporeal membranous oxygenation (ECMO) has been applied in patients with cardiopulmonary failure. One critical drawback of peripheral ECMO is an increase in left ventricular (LV) afterload which could be counterbalanced by the combination of intra-aortic balloon counter-pulsation (IABP) therapy. We hypothesized that an add-on therapy with IABP could improve outcomes in patients receiving ECMO support. We included patients (>18 years old) from 2002 to 2013 requiring ECMO support due to cardiogenic shock in a medical center. A total of 529 patients (227 ECMO alone and 302 combined IABP plus ECMO) were included. The mortality rates at 2 weeks (48.5 vs. 47.7%) after ECMO implantation were not different between the two groups (ECMO vs. combined group). After adjustment for propensity score and potential confounders, the odds ratios of outcomes within 14 days (combined group vs. ECMO) for poor LV systolic function, high preload, multi-organ failure and mortality were not different. The results remained similar for subgroup analysis. Compared with ECMO alone, combined IABP and ECMO treatment did not improve outcomes in patients with circulatory failure.

Modalities and Effects of Left Ventricle Unloading on Extracorporeal Life support: a Review of the Current Literature

“…Again, the same conclusions were reported by Lin et al in 529 patients (227 used ECMO alone and 302 combined IABP plus V‐A ECMO) …”

Concurrent Implantation of Intra‐Aortic Balloon Pump and Extracorporeal Membrane Oxygenation Improved Survival of Patients With Postcardiotomy Cardiogenic Shock

“…Similarly, Aso et al reported that 28‐day mortality and in‐hospital mortality were significantly lower in the combined group . However, Lin et al found the mortality rates at two weeks after ECMO implantation were not different between the ECMO group and combined group , which was consistent with a systematic review stating that there was a lack of survival benefit when using combined IABP and ECMO . Previous study included patients with all indications for short‐term mechanical circulatory support, which would induce confounding factors when interpreting the yield of combined use.…”

Short‐term outcomes of intra‐aortic balloon pump combined with venoarterial extracorporeal membrane oxygenation: A systematic review and meta‐analysis

“…The remaining 29 publications were reviewed in full-text and assessed against inclusion criteria. Finally, 12 studies were included in our study (5,(7)(8)(9)(15)(16)(17)(18)(19)(20)(21)(22). The search and selection process is depicted in a PRISMA flow diagram ( Figure 1).…”

“…However, the results from SHOCK II trial suggested that IABP did not reduce 30‐days mortality in patients with cardiogenic shock . The outcomes of IABP combined with VA‐ECMO were also disappointing in some observational studies , but a relatively small number of patients were enrolled.…”