Impella Versus Extracorporeal Membranous Oxygenation (ECMO) for Cardiogenic Shock: A Systematic Review and Meta-analysis

Ahmad, Soban; Ahsan, Muhammad Junaid; Ikram, Sundus; Lateef, Noman; Khan, Behram; Tabassum, Shehroze; Naeem, Aroma; Qavi, Ahmed Hassaan; Ardhanari, Sivakumar; Goldsweig, Andrew M.

doi:10.1016/j.cpcardiol.2022.101427

Cited by 14 publications

(10 citation statements)

References 38 publications

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“…Thus far, there are few studies identifying relevant diagnostic markers of critical limb ischaemia [ 8 , 46 ]. Authors described peripheral arterial disease, diabetes and concomitant IABP therapy as predictors for acute limb ischaemia [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Acute Limb Ischaemia during ECMO Support: A 6-Year Experience

Krasivskyi

Großmann

Dechow

et al. 2023

Life

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The use of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock is rising. Acute limb ischaemia remains one of the main complications after ECMO initiation. We analysed 104 patients from our databank from January 2015 to December 2021 who were supported with mobile ECMO therapy. We aimed to identify the impact of acute limb ischaemia on short-term outcomes in patients placed on ECMO in our institution. The main indication for ECMO therapy was left ventricular (LV) failure with cardiogenic shock (57.7%). Diameters of arterial cannulas (p = 0.365) showed no significant differences between both groups. Furthermore, concomitant intra-aortic balloon pump (IABP, p = 0.589) and Impella (p = 0.385) implantation did not differ significantly between both groups. Distal leg perfusion was established in approximately 70% of patients in two groups with no statistically significant difference (p = 0.960). Acute limb ischaemia occurred in 18.3% of cases (n = 19). In-hospital mortality was not significantly different (p = 0.799) in both groups. However, the bleeding rate was significantly higher (p = 0.005) in the limb ischaemia group compared to the no-limb ischaemia group. Therefore, early diagnosis and prevention of acute limb ischaemia might decrease haemorrhage complications in patients during ECMO therapy.

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Section: Discussionmentioning

confidence: 99%

Acute Limb Ischaemia during ECMO Support: A 6-Year Experience

Krasivskyi

Großmann

Dechow

et al. 2023

Life

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“…17 Like our study, higher in-hospital mortality in VA-ECMO patients compared to Impella patients has been reported previously. [16][17][18] However, as underscored by the recent publication of Almarzooq et al, 19 the differences in clinical outcomes between Impella and VA-ECMO in this observational data analysis must be interpreted in the setting of possible unmeasured and unadjusted confounders in patient and institutional characteristics. For instance due to physicians' preferences and device availability, but also depending on cardiogenic shock severity (according to the SCAI classification), risk modifiers, and cardiogenic shock phenotype.…”

Section: Costsmentioning

confidence: 95%

“…These findings are in accordance with previous literature, such as the meta-analysis from Ahmad et al, reporting significantly lower incidences of stroke, access-site bleeding, major bleeding, and limb ischaemia in Impella patients. 15,16 The findings are of importance as the literature shows that in addition to patient characteristics, adverse events are also associated with the device characteristics, such as the required arteriotomy size. Moreover, vascular complications are associated with higher mortality rates and in-hospital costs.…”

Section: Costsmentioning

confidence: 99%

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Impella and venoarterial extracorporeal membrane oxygenation in cardiogenic shock complicating acute myocardial infarction

Bogerd,

ten Berg,

Peters

et al. 2023

European J of Heart Fail

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AimsThis research aimed to give contemporary insight into the use of Impella and venoarterial extracorporeal membrane oxygenation (VA‐ECMO) in myocardial infarction‐related cardiogenic shock (AMICS) and into associated outcomes, adverse events, and resource demands.Methods and ResultsThis nationwide observational cohort study describes all AMICS patients treated with Impella(ABIOMED, Danvers, USA) and/or VA‐ECMO in 2020–2021. Impella and/or VA‐ECMO were used in 20% of all AMICS cases(n = 4088). Impella patients were older (34% vs 13% >75 years, p < 0.001) and less frequently presented after an out‐of‐hospital cardiac arrest (18% vs. 40%, p < 0.001). In‐hospital mortality was lower in the Impella versus VA‐ECMO cohort (61% vs. 67%, p = 0.001). Adverse events occurred less frequently in Impella‐supported patients: Acute haemorrhagic anaemia (36% vs. 68%, p < 0.001), cerebrovascular accidents (4% vs. 11%, p < 0.001), thromboembolisms of the extremities (5% vs. 8%, p < 0.001), systemic inflammatory response syndrome (21% vs. 25%, p = 0.004), acute kidney injury (44% vs. 53%, p < 0.001), and acute liver failure (7% vs. 12%, p < 0.001). Impella patients were discharged home directly more often (20% vs. 11%, p < 0.001) whereas VA‐ECMO patients were more often discharged to another care facility (22% vs. 19%, p = 0.031). Impella patients had shorter hospital stays and lower hospital costs.ConclusionThis is the largest, most recent European cohort study describing outcomes, adverse events, and resource demands based on claims data in patients with Impella and/or VA‐ECMO. Overall, adverse event rates and resource consumption were high. Given the current lack of beneficial evidence, our study reinforces the need for prospectively established, high‐quality evidence to guide clinical decision making.This article is protected by copyright. All rights reserved.

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“…The results confirm previous findings from smaller and/or older series. 5,6 Nevertheless, as stated by the authors, several differences were identified in the sub-populations studied: Impella™ patients were older (34% vs. 13%, age >75 years, p < 0.001), with more complex coronary lesion (three-vessel disease, 60% vs. 53%, p < 0.001) and less frequently hospitalized after out-of-hospital cardiac arrest (18% vs. 40%, p < 0.001) as compared to VA-ECMO patients.…”

Section: This Article Refers To 'Impella and Venoarterial Extracorpor...mentioning

confidence: 99%

Persistent high mortality in acute myocardial infarction‐associated cardiogenic shock despite early mechanical circulatory support: Need for stepwise and integrated approach of care

Delmas,

Vandenbriele,

Pappalardo

2023

European J of Heart Fail

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Impella Versus Extracorporeal Membranous Oxygenation (ECMO) for Cardiogenic Shock: A Systematic Review and Meta-analysis

Cited by 14 publications

References 38 publications

Acute Limb Ischaemia during ECMO Support: A 6-Year Experience

Acute Limb Ischaemia during ECMO Support: A 6-Year Experience

Impella and venoarterial extracorporeal membrane oxygenation in cardiogenic shock complicating acute myocardial infarction

Persistent high mortality in acute myocardial infarction‐associated cardiogenic shock despite early mechanical circulatory support: Need for stepwise and integrated approach of care

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