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

Abstract

The effectiveness of intra‐aortic balloon pump (IABP) combined with venoarterial extracorporeal membrane oxygenation (VA‐ECMO) in patients with cardiogenic shock or cardiac arrest remains controversial. The aim of this systematic review and meta‐analysis was to investigate the short‐term clinical outcomes of IABP combined with VA‐ECMO versus VA‐ECMO alone. We searched PubMed, Embase, and the Cochrane Library for English language articles published from inception to August 18, 2018. Observational studies comparing IABP combined with VA‐ECMO with VA‐ECMO were considered eligible for the current study. Twelve observational studies with 3704 patients were included. In the IABP combined with VA‐ECMO group mortality was 59.7%, compared with 65.8% in the VA‐ECMO alone group. The risk ratio (RR) for this comparison was 0.90 (95% confidence interval [CI], 0.80–1.02; P = 0.107; 59.7% vs. 65.8%). In the one‐way sensitivity analysis for estimating the effect of each study on mortality, omission of each study did not make a significant difference. Furthermore, the proportion of patients weaned from VA‐ECMO was significantly higher in IABP combined VA‐ECMO group than in the VA‐ECMO alone group (RR, 1.28; 95% CI, 1.21–1.35; P < 0.001; 77.9% vs. 61.2%). IABP combined with VA‐ECMO could improve success rate of weaning from VA‐ECMO, but did not reduce in‐hospital mortality in patients with cardiogenic shock or cardiac arrest.

An urgent open surgical approach for left ventricle venting during peripheral veno-arterial extracorporeal membrane oxygenation for refractory cardiac arrest: case report

“…In a recent meta-analysis, Wang et al found that an IABP could improve the success rate of weaning from VA-ECMO but did not reduce in-hospital mortality. 9 Others percutaneous techniques include atrial septostomy, atrial stenting, cannulation of the LV via a percutaneous pigtail stent, or the combination of a miniature axial blood pump associated with VA-ECMO. 2 In a recent multicenter, retrospective cohort study, this combination was found to be associated with a significantly lower in-hospital mortality rate, relative to treatment with VA-ECMO alone.…”

Strategies for Left Ventricular Decompression During Venoarterial Extracorporeal Membrane Oxygenation - A Narrative Review

“…IABP is frequently used in cardiogenic shock to improve diastolic coronary perfusion, as well as reduce left ventricular afterload and pulmonary edema. When used together with VA-ECMO it may improve coronary and cerebral perfusion, [68][69][70][71] facilitate left ventricular unloading and weaning from VA-ECMO, 72 reduce hospital mortality, 73 and reduce the risk of pulmonary edema 74 .…”

“…Wang et al 72 conducted a systematic review and meta-analysis of 12 observational studies including 3,704 patients supported with VA-ECMO with or without an IABP for cardiogenic shock or cardiac arrest. A greater proportion of patients in the VA-ECMO + IABP group were successfully weaned from VA-ECMO, compared with patients who received VA-ECMO without an IABP (77.9% v 61.2%; RR 1.28; 95% CI 1.21-1.35).…”

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“…Li Wang and Zhen Xing of The First Affiliated Hospital of Hebei North College, Hebei, People’s Republic of China studied the effectiveness of IABP combined with venoarterial extracorporeal membrane oxygenation (VA‐ECMO) in patients with cardiogenic shock or cardiac arrest by a systemic review and meta‐analysis to investigate the short‐term clinical outcomes of IABP combined with VA‐ECMO versus VA‐ECMO alone. They searched PubMed, Embase and the Cochrane Library for English language articles published from inception to August 18, 2018.…”