Left Ventricular Unloading With Impella Versus IABP in Patients With VA-ECMO: A Systematic Review and Meta-Analysis

Kruti D. Gandhi, Errol C. Moras, Shailesh Niroula, Persio D. Lopez, Devika Aggarwal, Kirtipal Bhatia, Yoni Balboul, Joseph Daibes, Ashish Correa, Abel Casso Dominguez, Edo Y. Birati, David A. Baran, Gregory Serrao, Kiran Mahmood, Saraschandra Vallabhajosyula, Arieh Fox

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Venoarterial extracorporeal membrane oxygenation (VA-ECMO) use for circulatory support in cardiogenic shock results in increased left ventricular (LV) afterload. The use of concomitant Impella or intra-aortic balloon pump (IABP) have been proposed as adjunct devices for LV unloading. The authors sought to compare head-to-head efficacy and safety outcomes between the 2 LV unloading strategies. We conducted a search of Medline, EMBASE, and Cochrane databases to identify studies comparing the use of Impella to IABP in patients on VA-ECMO. The primary outcome of interest was in-hospital mortality. The secondary outcomes included transition to durable LV assist devices/cardiac transplantation, stroke, limb ischemia, need for continuous renal replacement therapy, major bleeding, and hemolysis. Pooled risk ratios (RRs) with 95% confidence interval and heterogeneity statistic I2 were calculated using a random-effects model. A total of 7 observational studies with 698 patients were included. Patients on VA-ECMO unloaded with Impella vs IABP had similar risk of short-term all-cause mortality, defined as either 30-day or in-hospital mortality- 60.8% vs 64.9% (RR 0.93 [0.71 to 1.21], I2 = 71%). No significant difference was observed in transition to durable LV assist devices/cardiac transplantation, continuous renal replacement therapy initiation, stroke, or limb ischemia between the 2 strategies. However, the use of VA-ECMO with Impella was associated with increased risk of major bleeding (57.2% vs 39.7%) (RR 1.66 [1.12 to 2.44], I2 = 82%) and hemolysis (31% vs 7%) (RR 4.61 [1.24 to 17.17], I2 = 66%) compared with VA-ECMO, along with IABP. In conclusion, in patients requiring VA-ECMO for circulatory support, the concomitant use of Impella or IABP had comparable short-term mortality. However, Impella use was associated with increased risk of major bleeding and hemolysis.

Original languageEnglish
Pages (from-to)53-59
Number of pages7
JournalAmerican Journal of Cardiology
Volume208
DOIs
StatePublished - 1 Dec 2023

Bibliographical note

Publisher Copyright:
© 2023 Elsevier Inc.

Keywords

  • IABP
  • Impella
  • VA-ECMO
  • cardiogenic shock

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