Incidence and Outcomes of Acute Kidney Injury Requiring Renal Replacement Therapy in Patients on Percutaneous Mechanical Circulatory Support with Impella-CP for Cardiogenic Shock

Fahad, Fadi; Shaukat, Muhammad Hamza Saad; Yager, Neil

doi:10.7759/cureus.6591

Cited by 5 publications

(6 citation statements)

References 11 publications

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“…From 4173 articles, we reviewed 206 full-text articles. In total, we included 71 studies (63 observational, 8 PSM/RCTs) detailing 4280 adult patients that reported on the use of microaxial LVADs in CS ( Figure 1 ) [ 16 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 , 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 , 88 , 89 , 90 , 91 , 92 , 93 …”

Section: Resultsmentioning

confidence: 99%

Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Tan

Low²,

Ng³

et al. 2022

Life

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Microaxial left ventricular assist devices (LVAD) are increasingly used to support patients with cardiogenic shock; however, outcome results are limited to single-center studies, registry data and select reviews. We conducted a systematic review and meta-analysis, searching three databases for relevant studies reporting on microaxial LVAD use in adults with cardiogenic shock. We conducted a random-effects meta-analysis (DerSimonian and Laird) based on short-term mortality (primary outcome), long-term mortality and device complications (secondary outcomes). We assessed the risk of bias and certainty of evidence using the Joanna Briggs Institute and the GRADE approaches, respectively. A total of 63 observational studies (3896 patients), 6 propensity-score matched (PSM) studies and 2 randomized controlled trials (RCTs) were included (384 patients). The pooled short-term mortality from observational studies was 46.5% (95%-CI: 42.7–50.3%); this was 48.9% (95%-CI: 43.8–54.1%) amongst PSM studies and RCTs. The pooled mortality at 90 days, 6 months and 1 year was 41.8%, 51.1% and 54.3%, respectively. Hemolysis and access-site bleeding were the most common complications, each with a pooled incidence of around 20%. The reported mortality rate of microaxial LVADs was not significantly lower than extracorporeal membrane oxygenation (ECMO) or intra-aortic balloon pumps (IABP). Current evidence does not suggest any mortality benefit when compared to ECMO or IABP.

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Section: Resultsmentioning

confidence: 99%

Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Tan

Low²,

Ng³

et al. 2022

Life

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“…Biological defense mechanisms maintain central perfusion during pathological conditions requiring ECMO by reducing perfusion of peripheral organs ‐such as the kidney. However, the role of additional Impella® implantation on acute kidney failure remains unclear and clinical data is scarce 28–30 …”

Section: Discussionmentioning

confidence: 99%

“…However, the role of additional Impella® implantation on acute kidney failure remains unclear and clinical data is scarce. [28][29][30] In summary, complications like the higher need for renal replacement therapy, bleeding, and limb ischemia might be explained by increased survival. Thus, patients are more exposed to the risk of suffering complications.…”

Section: Impella® Placementmentioning

confidence: 99%

Impact of left ventricular unloading using a peripheral Impella®‐pump in eCPR patients

et al. 2021

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Background Extracorporeal cardiopulmonary resuscitation (eCPR) is a rapidly growing treatment strategy due to increasing survival rates in selected patients. Additional left ventricular mechanical unloading, using a transfemoral micro‐axial blood pump (Impella® Denver, Massachusetts, USA), might improve patients’ outcomes. In this regard, we sought to investigate patients who suffered OHCA (out‐of hospital cardiac arrest) or IHCA (in‐hospital cardiac arrest) with subsequent eCPR via VA‐ECMO (veno‐arterial extracorporeal membrane oxygenation) and concomitant Impella® implantation based on survival and feasibility of ECMO weaning. Methods From January 2016 until December 2020, 108 patients underwent eCPR at our institution. Data prior to eCPR and early outcome parameters were analyzed comparing patients who were supported with an additional Impella® (2.5 or CP) (ECMO+Impella®, n = 18) and patients without additional (ECMO, n = 90) support during V‐A ECMO therapy. The primary endpoint was in‐hospital mortality; secondary endpoints were, among others: ECMO explantation, need for hemodialysis, stroke, and need for blood transfusions. Results Low‐flow time was significantly lower in the ECMO+Impella group (60 min vs. 55 min, p = .01). All‐cause mortality was significantly lower in the ECMO+Impella® group (82% vs. 56%, p = .01). The time of circulatory support was shorter in the ECMO cohort (2.0 ± 1.73 vs. 4.76 ± 2.88 p = .05). ECMO decannulation was significantly more feasible in patients with ECMO+Impella® (72% vs. 32%, p = .01). Patients treated with additional Impella® showed significantly more acute kidney injury with the need for dialysis (72% vs. 18%, p ≤ .01). Conclusion Concomitant Impella® support might positively influence survival and ECMO weaning in eCPR patients. Treatment‐associated complications such as the need for dialysis were more common in this highly selected patient group. Further studies with larger numbers are necessary to evaluate the clinical relevance of concomitant LV‐unloading in eCPR patients using an Impella® device.

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“…Studies on the treatment of CS with Impella and VA-ECMO are primarily set in Europe (42, 41%) [20,, followed by North and South America (38, 37%) [2,7,, Asia (20, 20%) [3,4,8,[106][107][108][109][110][111][112][113][114][115][116][117][118], the Middle East and Africa (2, 2%) [119,120]. The United States is where most of the studies are conducted (35, 34%) [2,7,[70][71][72][74][75][76][77][78][79][81][82][83][84][85][86][87][88][89][90][91][92][93][94][96][97][98]...…”

Section: Characteristics Of Included Studiesmentioning

confidence: 99%

Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Comprehensive Systematic Literature Review and Meta-Analyses

Ardito

Sarucanian

Rognoni

et al. 2023

JCDD

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Impella and VA-ECMO are two possible therapeutic courses for the treatment of patients with cardiogenic shock (CS). The study aims to perform a systematic literature review and meta-analyses of a comprehensive set of clinical and socio-economic outcomes observed when using Impella or VA-ECMO with patients under CS. A systematic literature review was performed in Medline, and Web of Science databases on 21 February 2022. Nonoverlapping studies with adult patients supported for CS with Impella or VA-ECMO were searched. Study designs including RCTs, observational studies, and economic evaluations were considered. Data on patient characteristics, type of support, and outcomes were extracted. Additionally, meta-analyses were performed on the most relevant and recurring outcomes, and results shown using forest plots. A total of 102 studies were included, 57% on Impella, 43% on VA-ECMO. The most common outcomes investigated were mortality/survival, duration of support, and bleeding. Ischemic stroke was lower in patients treated with Impella compared to the VA-ECMO population, with statistically significant difference. Socio-economic outcomes including quality of life or resource use were not reported in any study. The study highlighted areas where further data collection is needed to clarify the value of complex, new technologies in the treatment of CS that will enable comparative assessments focusing both on the health impact on patient outcomes and on the financial burden for government budgets. Future studies need to fill the gap to comply with recent regulatory updates at the European and national levels.

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Incidence and Outcomes of Acute Kidney Injury Requiring Renal Replacement Therapy in Patients on Percutaneous Mechanical Circulatory Support with Impella-CP for Cardiogenic Shock

Cited by 5 publications

References 11 publications

Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Microaxial Left Ventricular Assist Device in Cardiogenic Shock: A Systematic Review and Meta-Analysis

Impact of left ventricular unloading using a peripheral Impella®‐pump in eCPR patients

Impella Versus VA-ECMO for Patients with Cardiogenic Shock: Comprehensive Systematic Literature Review and Meta-Analyses

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