PMID- 32531130
OWN - NLM
STAT- MEDLINE
DCOM- 20201015
LR  - 20201015
IS  - 1540-8191 (Electronic)
IS  - 0886-0440 (Linking)
VI  - 35
IP  - 6
DP  - 2020 Jun
TI  - Impella to unload the left ventricle in patients undergoing venoarterial 
      extracorporeal membrane oxygenation for cardiogenic shock: A systematic review 
      and meta-analysis.
PG  - 1237-1242
LID - 10.1111/jocs.14560 [doi]
AB  - BACKGROUND AND AIM: Impella is frequently used to unload the left ventricle in 
      patients with cardiogenic shock on venoarterial extracorporeal membrane 
      oxygenation (VA-ECMO). There is limited data regarding the use of this strategy. 
      This study aims to evaluate the safety and efficacy of the said strategy. 
      METHODS: A systematic search for studies comparing Impella plus VA-ECMO (ECVAD) 
      vs VA-ECMO alone was performed using Pubmed, Cochrane Library, and Scopus. 
      Studies meeting inclusion criteria were then used to perform a meta-analysis. 
      RESULTS: Three studies involving 448 patients were included in the final 
      analysis. In total, 117 (26%) patients were female, mean age was 57 years. 
      VA-ECMO was placed in 355 out of 448 (79%) patients, while ECVAD was placed in 93 
      out of 448 (21%). Death occurred in 49 out of 93 (52.6%) patients on ECVAD and 
      226 out of 355 (63.6%) on ECMO, relative risk (RR): 0.76, confidence interval 
      (CI), 95% (0.62-0.94) P = .01. Hemolysis was present in 46 (49.4%) patients in 
      the ECVAD vs 67 (18%) in the ECMO group, RR: 2.64, CI, 95% (1.97-3.55) P < .01. 
      Bleeding was present in 42 (45.2.%) patients in the ECVAD group and 135 (38%) in 
      the ECMO group, RR: 1.25, CI, 95% (0.95-1.63) P = .11. CVVHD was used on 31 
      (33.3%) patients in the ECVAD group while 89 (25%) in the ECMO group, RR 1.35, 
      CI, 95% (0.95-1.91) P = .10. CONCLUSION: This study suggests that the use of 
      Impella as an unloading strategy in patients with VA-ECMO decreased mortality, 
      increased rate of hemolysis, neutral bleeding risk, and similar rates of acute 
      kidney injury requiring CVVHD.
CI  - (c) 2020 Wiley Periodicals, Inc.
FAU - Grajeda Silvestri, Edwin R
AU  - Grajeda Silvestri ER
AUID- ORCID: 0000-0003-2536-7063
AD  - Internal Medicine/Cardiology, University of Miami/JFK Medical Center Palm Beach 
      Regional GME Consortium, Atlantis, Florida.
FAU - Pino, Jesus E
AU  - Pino JE
AUID- ORCID: 0000-0003-1920-9392
AD  - Internal Medicine/Cardiology, University of Miami/JFK Medical Center Palm Beach 
      Regional GME Consortium, Atlantis, Florida.
FAU - Donath, Elie
AU  - Donath E
AD  - Internal Medicine/Cardiology, University of Miami/JFK Medical Center Palm Beach 
      Regional GME Consortium, Atlantis, Florida.
FAU - Torres, Pedro
AU  - Torres P
AD  - Internal Medicine/Cardiology, University of Miami/JFK Medical Center Palm Beach 
      Regional GME Consortium, Atlantis, Florida.
FAU - Chait, Robert
AU  - Chait R
AD  - Internal Medicine/Cardiology, University of Miami/JFK Medical Center Palm Beach 
      Regional GME Consortium, Atlantis, Florida.
FAU - Ghumman, Waqas
AU  - Ghumman W
AD  - Internal Medicine/Cardiology, University of Miami/JFK Medical Center Palm Beach 
      Regional GME Consortium, Atlantis, Florida.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
DEP - 20200419
PL  - United States
TA  - J Card Surg
JT  - Journal of cardiac surgery
JID - 8908809
SB  - IM
MH  - Adult
MH  - Aged
MH  - Extracorporeal Membrane Oxygenation/*methods
MH  - Female
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Safety
MH  - Shock, Cardiogenic/mortality/physiopathology/*therapy
MH  - Treatment Outcome
MH  - Ventricular Function, Left
OTO - NOTNLM
OT  - Impella
OT  - LV unloading
OT  - VA-ECMO
OT  - afterload
OT  - mechanical circulatory support
EDAT- 2020/06/13 06:00
MHDA- 2020/10/21 06:00
CRDT- 2020/06/13 06:00
PHST- 2020/06/13 06:00 [entrez]
PHST- 2020/06/13 06:00 [pubmed]
PHST- 2020/10/21 06:00 [medline]
AID - 10.1111/jocs.14560 [doi]
PST - ppublish
SO  - J Card Surg. 2020 Jun;35(6):1237-1242. doi: 10.1111/jocs.14560. Epub 2020 Apr 19.