Background
Recent research increasingly highlights the importance of extracorporeal veno-arterial membrane oxygenation (VA-ECMO) with (ECpella) or without Impella for the management of refractory cardiogenic shock (CS) resulting from acute myocardial infarction (AMI). However, there is a notable lack of large-scale, randomized trials that aim to head-to-head comparison of VA-ECMO versus ECpella for treating AMI-related CS.
Methods
This meta-analysis included exclusively studies examining patients undergoing treatment with VA-ECMO with or without Impella for managing AMI-related CS. The primary outcome was the 30-day mortality rate, while secondary outcomes were major bleeding events and ischemic vascular complications.
Results
A total of 13 studies involving 8,288 patients were incorporated into this meta-analysis. The results indicated that the ECpella strategy (2,652 patients) was associated with a significantly reduced 30-day mortality rate when compared to VA-ECMO alone (5,636 patients) ((Relative Risk Ratio (RR) 0.88, Confidence Interval (C.I.) 0.78 to 0.99, p=0.04) Figure 1), although the use of ECmella led to statistically significant higher ischemia (RR 1.49, C.I. 1.01 to 2.19, p=0.045, Figure 2) and bleeding complications (RR 1.44, C.I. 1.09 to 1.9, p=0.01 Figure 3). Lactate, age, pH were similar in both groups Figures 4-6). According to the characteristic of each study, there was not a high possibility of publication bias (Figure 7).
Conclusions
This meta-analysis indicates that the use of ECpella may be linked to a reduced mortality rate compared to VA-ECMO alone in ischemia-induced CS, despite the higher ischemic and bleeding complications associated with the combined use of these devices. Our findings may imply that Impella should serve as an early escalation therapy option for patients experiencing AMI-related CS treated with a VA-ECMO.
