PMID- 36370449
OWN - NLM
STAT- MEDLINE
DCOM- 20230623
LR  - 20230627
IS  - 2058-1742 (Electronic)
IS  - 2058-1742 (Linking)
VI  - 9
IP  - 4
DP  - 2023 Jun 21
TI  - Venoarterial extracorporeal membrane oxygenation (VA-ECMO) with vs. without left 
      ventricular unloading by Impella: a systematic review and meta-analysis.
PG  - 358-366
LID - 10.1093/ehjqcco/qcac076 [doi]
AB  - BACKGROUND AND AIMS: The use of venoarterial extracorporeal membrane oxygenation 
      (VA-ECMO) for the treatment of cardiogenic shock (CS) may result in left 
      ventricle overload and distension. Percutaneous microaxial flow pump Impella in 
      addition to VA-ECMO (ECPELLA) is an emerging option to overcome these collateral 
      effects. Aim of this study is to assess whether the addition of Impella to 
      VA-ECMO is an effective and safe unloading strategy. METHODS AND RESULTS: We 
      performed a systematic literature review of studies comparing ECPELLA vs. ECMO 
      alone in patients with CS. The primary endpoint was early mortality (in-hospital 
      or 30-day mortality). The secondary endpoints were bleeding, need for kidney 
      replacement therapy, haemolysis, infections, and limb ischaemia. A total of 3469 
      potentially relevant articles were screened and eight retrospective studies 
      including 11.137 patients were selected. There was no significant difference in 
      early mortality (Risk Ratio, RR 0.90, 95% CI 0.78-1.03) between ECPELLA and ECMO. 
      Nevertheless, there was a borderline significant reduction in early mortality 
      with ECPELLA (RR 0.74, 95% CI 0.55-1.00) at sensitivity analysis selectively 
      including studies reporting propensity matched analysis. ECPELLA was associated 
      with increased bleeding (RR 1.45, 95% CI 1.20-1.75), need for kidney replacement 
      therapy (RR 1.54, 95% CI 1.19-1.99), haemolysis (RR 1.71, 95% CI 1.41-2.07) and 
      limb ischaemia (RR 1.43, 95% CI 1.17-1.75) and with a non-significant increase in 
      severe infections (RR 1.26, 95% CI 0.84-1.89), compared with ECMO alone. 
      CONCLUSION: Among patients with cardiogenic shock, ECPELLA is associated with 
      increased complications compared with ECMO. Whether reducing ventricular overload 
      with Impella among patients treated with ECMO reduces early mortality needs to be 
      confirmed by further investigations.
CI  - (c) The Author(s) 2022. Published by Oxford University Press on behalf of the 
      European Society of Cardiology.
FAU - Cappannoli, Luigi
AU  - Cappannoli L
AUID- ORCID: 0000-0002-6905-9268
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
FAU - Galli, Mattia
AU  - Galli M
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
AD  - Maria Cecilia Hospital, GVM Care & Research, Cotignola 48033, Italy.
FAU - Zito, Andrea
AU  - Zito A
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
FAU - Restivo, Attilio
AU  - Restivo A
AUID- ORCID: 0000-0002-9097-5287
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
FAU - Princi, Giuseppe
AU  - Princi G
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
FAU - Laborante, Renzo
AU  - Laborante R
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
FAU - Vergallo, Rocco
AU  - Vergallo R
AUID- ORCID: 0000-0001-5577-081X
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - Romagnoli, Enrico
AU  - Romagnoli E
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - Leone, Antonio Maria
AU  - Leone AM
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - Aurigemma, Cristina
AU  - Aurigemma C
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - Massetti, Massimo
AU  - Massetti M
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - Sanna, Tommaso
AU  - Sanna T
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - Trani, Carlo
AU  - Trani C
AUID- ORCID: 0000-0001-9777-013X
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - Burzotta, Francesco
AU  - Burzotta F
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - Savarese, Gianluigi
AU  - Savarese G
AD  - Division of Cardiology, Department of Medicine, Karolinska Institutet, Solna 
      17164, Stockholm, Sweden.
FAU - Crea, Filippo
AU  - Crea F
AUID- ORCID: 0000-0001-9404-8846
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
FAU - D'Amario, Domenico
AU  - D'Amario D
AUID- ORCID: 0000-0003-3774-8330
AD  - Universita Cattolica del Sacro Cuore (UCSC), Rome 00168, Italy.
AD  - Dipartimento di Scienze Cardiovascolari, Fondazione Policlinico Universitario A. 
      Gemelli IRCCS, Rome 00168, Italy.
LA  - eng
PT  - Journal Article
PT  - Meta-Analysis
PT  - Systematic Review
PL  - England
TA  - Eur Heart J Qual Care Clin Outcomes
JT  - European heart journal. Quality of care & clinical outcomes
JID - 101677796
SB  - IM
CIN - Eur Heart J Qual Care Clin Outcomes. 2023 Jun 21;9(4):307-309. PMID: 36577146
MH  - Humans
MH  - Shock, Cardiogenic/therapy
MH  - Retrospective Studies
MH  - *Extracorporeal Membrane Oxygenation/adverse effects/methods
MH  - Heart Ventricles
MH  - Hemolysis
MH  - *Heart-Assist Devices
OTO - NOTNLM
OT  - Cardiogenic shock
OT  - ECMO
OT  - ECPELLA
OT  - Impella
OT  - PVAD
OT  - Unloading
OT  - Venting
EDAT- 2022/11/13 06:00
MHDA- 2023/06/23 06:42
CRDT- 2022/11/12 14:42
PHST- 2022/09/10 00:00 [received]
PHST- 2022/11/03 00:00 [revised]
PHST- 2022/11/10 00:00 [accepted]
PHST- 2023/06/23 06:42 [medline]
PHST- 2022/11/13 06:00 [pubmed]
PHST- 2022/11/12 14:42 [entrez]
AID - 6825448 [pii]
AID - 10.1093/ehjqcco/qcac076 [doi]
PST - ppublish
SO  - Eur Heart J Qual Care Clin Outcomes. 2023 Jun 21;9(4):358-366. doi: 
      10.1093/ehjqcco/qcac076.