Ahmad S, Ahsan MJ, Ikram S, Lateef N, Khan BA, Tabassum S, Naeem A, Qavi AH, Ardhanari S, Goldsweig AM. Impella versus extracorporeal membranous oxygenation (ECMO) for cardiogenic shock: a systematic review and meta-analysis.
Curr Probl Cardiol 2022;
48:101427. [PMID:
36174742 DOI:
10.1016/j.cpcardiol.2022.101427]
[Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 10/14/2022]
Abstract
BACKGROUND
The use of mechanical circulatory support (MCS) in cardiogenic shock (CS) is increasing. We conducted a systematic review and meta-analysis to compare outcomes with the Impella device vs. ECMO in patients with CS.
METHODS
We searched the Medline, EMBASE, Cochrane, and Clinicaltrials.gov databases for observational studies comparing Impella to ECMO in patients with CS. Risk ratios (RRs) for categorical variables and standardized mean differences (SMDs) for continuous variables were calculated with 95% confidence intervals (CIs) using a random-effects model.
RESULTS
Twelve retrospective studies and one prospective study (Impella n=6652, ECMO n=1232) were identified. Impella use was associated with lower incidence of in-hospital mortality (RR 0.88 [95% CI 0.80-0.94], p=0.0004), stroke (RR 0.30 [0.21-0.42], p<0.00001), access-site bleeding (RR 0.50 [0.37-0.69], p<0.0001), major bleeding (RR 0.56 [0.39-0.80], p=0.002), and limb ischemia (RR 0.42 [0.27-0.65], p=0.0001). Baseline lactate levels were significantly lower in the Impella group (SMD -0.52 [-0.73- -0.31], p<0.00001). There was no significant difference in mortality at 6-12 months, MCS duration, need for MCS escalation, bridge-to-LVAD or heart transplant, and renal replacement therapy use between Impella and ECMO groups.
CONCLUSION
In patients with CS, Impella device use was associated with lower in-hospital mortality, stroke, and device-related complications than ECMO. However, patients in the ECMO group had higher baseline lactate levels.
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