PMID- 38180032 OWN - NLM STAT- MEDLINE DCOM- 20240222 LR - 20240222 IS - 1530-0293 (Electronic) IS - 0090-3493 (Print) IS - 0090-3493 (Linking) VI - 52 IP - 3 DP - 2024 Mar 1 TI - Left-Ventricular Unloading With Impella During Refractory Cardiac Arrest Treated With Extracorporeal Cardiopulmonary Resuscitation: A Systematic Review and Meta-Analysis. PG - 464-474 LID - 10.1097/CCM.0000000000006157 [doi] AB - OBJECTIVES: Extracorporeal cardiopulmonary resuscitation (ECPR) is the implementation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) during refractory cardiac arrest. The role of left-ventricular (LV) unloading with Impella in addition to VA-ECMO ("ECMELLA") remains unclear during ECPR. This is the first systematic review and meta-analysis to characterize patients with ECPR receiving LV unloading and to compare in-hospital mortality between ECMELLA and VA-ECMO during ECPR. DATA SOURCES: Medline, Cochrane Central Register of Controlled Trials, Embase, and abstract websites of the three largest cardiology societies (American Heart Association, American College of Cardiology, and European Society of Cardiology). STUDY SELECTION: Observational studies with adult patients with refractory cardiac arrest receiving ECPR with ECMELLA or VA-ECMO until July 2023 according to the Preferred Reported Items for Systematic Reviews and Meta-Analysis checklist. DATA EXTRACTION: Patient and treatment characteristics and in-hospital mortality from 13 study records at 32 hospitals with a total of 1014 ECPR patients. Odds ratios (ORs) and 95% CI were computed with the Mantel-Haenszel test using a random-effects model. DATA SYNTHESIS: Seven hundred sixty-two patients (75.1%) received VA-ECMO and 252 (24.9%) ECMELLA. Compared with VA-ECMO, the ECMELLA group was comprised of more patients with initial shockable electrocardiogram rhythms (58.6% vs. 49.3%), acute myocardial infarctions (79.7% vs. 51.5%), and percutaneous coronary interventions (79.0% vs. 47.5%). VA-ECMO alone was more frequently used in pulmonary embolism (9.5% vs. 0.7%). Age, rate of out-of-hospital cardiac arrest, and low-flow times were similar between both groups. ECMELLA support was associated with reduced odds of mortality (OR, 0.53 [95% CI, 0.30-0.91]) and higher odds of good neurologic outcome (OR, 2.22 [95% CI, 1.17-4.22]) compared with VA-ECMO support alone. ECMELLA therapy was associated with numerically increased but not significantly higher complication rates. Primary results remained robust in multiple sensitivity analyses. CONCLUSIONS: ECMELLA support was predominantly used in patients with acute myocardial infarction and VA-ECMO for pulmonary embolism. ECMELLA support during ECPR might be associated with improved survival and neurologic outcome despite higher complication rates. However, indications and frequency of ECMELLA support varied strongly between institutions. Further scientific evidence is urgently required to elaborate standardized guidelines for the use of LV unloading during ECPR. CI - Copyright (c) 2024 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. FAU - Thevathasan, Tharusan AU - Thevathasan T AD - Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Campus Benjamin Franklin, Berlin, Germany. AD - Berlin Institute of Health, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. AD - Institute of Medical Informatics, Charite-Universitatsmedizin Berlin, Berlin, Germany. AD - Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark. AD - Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lubeck, Lubeck, Germany. AD - Department of Cardiology and Angiology, Medical Faculty, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Freiburg, Germany. AD - Department of Cardiology, Odense University Hospital, Odense, Denmark. AD - Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark. AD - Department of Aneastesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark. AD - Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany. AD - Department of Cardiology and Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan. AD - Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. AD - Department of Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY. AD - Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal. AD - Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ. AD - Cardiology Department, University Hospital of Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), Salamanca, Spain. AD - Centro de Investigacion biomedica en Red de Enfermadades Cardiovasculares (CIBER-CV), Madrid, Spain. AD - Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. AD - Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. AD - Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX. FAU - Fureder, Lisa AU - Fureder L AD - Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Campus Benjamin Franklin, Berlin, Germany. FAU - Fechtner, Marie AU - Fechtner M AD - Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Campus Benjamin Franklin, Berlin, Germany. FAU - Mork, Sivagowry Rasalingam AU - Mork SR AD - Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark. FAU - Schrage, Benedikt AU - Schrage B AD - Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lubeck, Lubeck, Germany. FAU - Westermann, Dirk AU - Westermann D AD - Department of Cardiology and Angiology, Medical Faculty, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Freiburg, Germany. FAU - Linde, Louise AU - Linde L AD - Department of Cardiology, Odense University Hospital, Odense, Denmark. FAU - Gregers, Emilie AU - Gregers E AD - Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark. FAU - Andreasen, Jo Bonding AU - Andreasen JB AD - Department of Aneastesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark. FAU - Gaisendrees, Christopher AU - Gaisendrees C AD - Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany. FAU - Unoki, Takashi AU - Unoki T AD - Department of Cardiology and Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan. FAU - Axtell, Andrea L AU - Axtell AL AD - Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. FAU - Takeda, Koji AU - Takeda K AD - Department of Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY. FAU - Vinogradsky, Alice V AU - Vinogradsky AV AD - Department of Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY. FAU - Goncalves-Teixeira, Pedro AU - Goncalves-Teixeira P AD - Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal. FAU - Lemaire, Anthony AU - Lemaire A AD - Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ. FAU - Alonso-Fernandez-Gatta, Marta AU - Alonso-Fernandez-Gatta M AD - Cardiology Department, University Hospital of Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), Salamanca, Spain. AD - Centro de Investigacion biomedica en Red de Enfermadades Cardiovasculares (CIBER-CV), Madrid, Spain. FAU - Sern Lim, Hoong AU - Sern Lim H AD - Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. FAU - Garan, Arthur Reshad AU - Garan AR AD - Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. FAU - Bindra, Amarinder AU - Bindra A AD - Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX. FAU - Schwartz, Gary AU - Schwartz G AD - Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX. FAU - Landmesser, Ulf AU - Landmesser U AD - Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Campus Benjamin Franklin, Berlin, Germany. AD - Berlin Institute of Health, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. AD - Institute of Medical Informatics, Charite-Universitatsmedizin Berlin, Berlin, Germany. AD - Department of Cardiology, Aarhus University Hospital, Aarhus N, Denmark. AD - Department of Cardiology, University Heart and Vascular Centre Hamburg, Hamburg, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Lubeck, Lubeck, Germany. AD - Department of Cardiology and Angiology, Medical Faculty, University Heart Center Freiburg, Bad Krozingen, University of Freiburg, Freiburg, Germany. AD - Department of Cardiology, Odense University Hospital, Odense, Denmark. AD - Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark. AD - Department of Aneastesiology and Intensive Care, Aalborg University Hospital, Aalborg, Denmark. AD - Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany. AD - Department of Cardiology and Intensive Care Unit, Saiseikai Kumamoto Hospital, Kumamoto, Japan. AD - Division of Cardiac Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA. AD - Department of Surgery, Columbia University Medical Center/New York-Presbyterian Hospital, New York, NY. AD - Department of Cardiology, Centro Hospitalar de Vila Nova de Gaia/Espinho, Oporto, Portugal. AD - Division of Cardiothoracic Surgery, Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ. AD - Cardiology Department, University Hospital of Salamanca, Instituto de Investigacion Biomedica de Salamanca (IBSAL), Salamanca, Spain. AD - Centro de Investigacion biomedica en Red de Enfermadades Cardiovasculares (CIBER-CV), Madrid, Spain. AD - Department of Cardiology, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom. AD - Division of Cardiology, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. AD - Center for Advanced Heart and Lung Disease, Baylor University Medical Center, Dallas, TX. FAU - Skurk, Carsten AU - Skurk C AD - Department of Cardiology, Angiology and Intensive Care Medicine, Deutsches Herzzentrum der Charite, Campus Benjamin Franklin, Berlin, Germany. AD - DZHK (German Centre for Cardiovascular Research), partner site Berlin, Berlin, Germany. LA - eng PT - Journal Article PT - Meta-Analysis PT - Systematic Review DEP - 20240105 PL - United States TA - Crit Care Med JT - Critical care medicine JID - 0355501 SB - IM MH - Adult MH - Humans MH - *Cardiopulmonary Resuscitation/methods MH - Shock, Cardiogenic/therapy MH - *Out-of-Hospital Cardiac Arrest/therapy MH - *Myocardial Infarction MH - *Pulmonary Embolism MH - Retrospective Studies PMC - PMC10876179 COIS- Drs. Schrage and Garan received funding from Abiomed. Dr. Schrage received funding from Abbott and AstraZeneca. Dr. Westermann received grants for honorary talks from AstraZeneca, Abiomed, Bayer, Boehringer Ingelheim, Edwards, Novartis, and Medtronic. Dr. Gregers received funding from the Odense University Hospital, Rigshospitalet's Common Research Foundation, Novo Nordisk Foundation, and Beckett Foundation. Dr. Alonso-Fernandez-Gatta received funding from Instituto de Salud Carlos III (CM19/00055). Dr. Garan received funding from NuPulseCV and Maquet; he received support for article research from Abbott. The remaining authors have disclosed that they do not have any potential conflicts of interest. EDAT- 2024/01/05 12:43 MHDA- 2024/02/22 06:42 PMCR- 2024/02/19 CRDT- 2024/01/05 09:43 PHST- 2024/02/22 06:42 [medline] PHST- 2024/01/05 12:43 [pubmed] PHST- 2024/01/05 09:43 [entrez] PHST- 2024/02/19 00:00 [pmc-release] AID - 00003246-990000000-00259 [pii] AID - 10.1097/CCM.0000000000006157 [doi] PST - ppublish SO - Crit Care Med. 2024 Mar 1;52(3):464-474. doi: 10.1097/CCM.0000000000006157. Epub 2024 Jan 5.