PMID- 34957789
OWN - NLM
STAT- MEDLINE
DCOM- 20220323
LR  - 20220323
IS  - 1530-6550 (Print)
IS  - 1530-6550 (Linking)
VI  - 22
IP  - 4
DP  - 2021 Dec 22
TI  - Impella as unloading strategy during VA-ECMO: systematic review and 
      meta-analysis.
PG  - 1503-1511
LID - 10.31083/j.rcm2204154 [doi]
AB  - Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is used as mechanical 
      circulatory support in cardiogenic shock (CS). It restores peripheral perfusion, 
      at the expense of increased left ventricle (LV) afterload. In this setting, 
      Impella can be used as direct unloading strategy. Aim of this meta-analysis was 
      to investigate efficacy and safety of LV unloading with Impella during ECMO in 
      CS. A systematic search on Medline, Scopus and Cochrane Library was performed 
      using as combination of keywords: extracorporeal membrane oxygenation, Impella, 
      percutaneous micro axial pump, ECPELLA, cardiogenic shock. We aimed to include 
      studies, which compared the use of ECMO with and without Impella (ECPELLA vs. 
      ECMO). Primary endpoint was short-term all-cause mortality; secondary endpoints 
      included major bleeding, haemolysis, need for renal replacement therapy (RRT) and 
      cerebrovascular accident (CVA). Five studies met the inclusion criteria, with a 
      total population of 972 patients. The ECPELLA cohort showed improved survival 
      compared to the control group (RR (Risk Ratio): 0.86; 95% CI (Confidence 
      Interval): 0.76, 0.96; p = 0.009). When including in the analysis only studies 
      with homogeneous comparator groups, LV unloading with Impella remained associated 
      with significant reduction in mortality (RR: 0.85; 95% CI: 0.75, 0.97; p = 0.01). 
      Haemolysis (RR: 1.70; 95% CI: 1.35, 2.15; p < 0.00001) and RRT (RR: 1.86; 95% CI: 
      1.07, 3.21; p = 0.03) occurred at a higher rate in the ECPELLA group. There was 
      no difference between the two groups in terms of major bleeding (RR: 1.37; 95% 
      CI: 0.88, 2.13; p = 0.16) and CVA (RR: 0.91; 95% CI: 0.61, 1.38; p = 0.66). In 
      conclusion, LV unloading with Impella during ECMO was associated with improved 
      survival, despite increased haemolysis and need for RRT, without additional risk 
      of major bleeding and CVA.
CI  - (c) 2021 The Author(s). Published by IMR Press.
FAU - Fiorelli, Francesca
AU  - Fiorelli F
AD  - Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St 
      Thomas' NHS Foundation Trust, Harefield Hospital, UB9 6JH Harefield, UK.
FAU - Panoulas, Vasileios
AU  - Panoulas V
AD  - Department of Cardiology, Royal Brompton and Harefield Hospitals, Guy's and St 
      Thomas' NHS Foundation Trust, Harefield Hospital, UB9 6JH Harefield, UK.
AD  - Cardiovascular Sciences, National Heart and Lung Institute, Imperial College, SW3 
      6LY London, UK.
LA  - eng
PT  - Meta-Analysis
PT  - Systematic Review
PL  - Singapore
TA  - Rev Cardiovasc Med
JT  - Reviews in cardiovascular medicine
JID - 100960007
SB  - IM
CIN - Rev Cardiovasc Med. 2022 Jan 8;23(1):3. PMID: 35092195
MH  - *Extracorporeal Membrane Oxygenation/adverse effects
MH  - Heart Ventricles
MH  - *Heart-Assist Devices
MH  - Humans
MH  - Shock, Cardiogenic/diagnosis/therapy
MH  - *Stroke
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - ECMO
OT  - ECPELLA
OT  - Impella
OT  - Left ventricular unloading
OT  - Meta-analysis
COIS- The authors declare no conflict of interest. Vasileios Panoulas is serving as one 
      of the Editorial Board members of this journal. We declare that Vasileios 
      Panoulas had no involvement in the peer review of this article and has no access 
      to information regarding its peer review. Full responsibility for the editorial 
      process for this article was delegated to Karim Bendjelid and John Lynn 
      Jefferies.
EDAT- 2021/12/28 06:00
MHDA- 2022/03/24 06:00
CRDT- 2021/12/27 07:10
PHST- 2021/08/12 00:00 [received]
PHST- 2021/09/22 00:00 [revised]
PHST- 2021/10/13 00:00 [accepted]
PHST- 2021/12/27 07:10 [entrez]
PHST- 2021/12/28 06:00 [pubmed]
PHST- 2022/03/24 06:00 [medline]
AID - S1530-6550(21)00275-1 [pii]
AID - 10.31083/j.rcm2204154 [doi]
PST - ppublish
SO  - Rev Cardiovasc Med. 2021 Dec 22;22(4):1503-1511. doi: 10.31083/j.rcm2204154.