The Effect of Different Types of Mechanical Circulatory Support on Mortality of Patients after Adult Cardiac Surgery: A Systematic Review and Meta-Analysis
A systematic review and meta-analysis
DOI:
https://doi.org/10.1532/hsf.2979Keywords:
Intra-aortic balloon pump; Extra-corporeal membrane oxygenation; Cardiac surgery; Post-cardiotomy shockAbstract
Objectives: Sample size may limit the ability of individual studies to detect differences in clinical outcomes between extracorporeal membrane oxygenation (ECMO) alone and ECMO plus intra-aortic balloon pump (IABP) after adult cardiac surgery. Therefore, we undertook a meta-analysis of the best evidence available on the comparison of clinical outcomes of ECMO alone and ECMO plus IABP after adult cardiac surgery.
Methods: PubMed, EMBASE, Web of Science, and Cochrane Center Registry of Controlled Trials were searched for studies comparing the use of ECMO alone and ECMO plus IABP after adult cardiac surgery. A meta-analysis and a sensitivity analysis were conducted.
Results: Among the 472 screened articles, 24 studies (1302 cases of ECMO plus IABP and 1603 cases of ECMO) were included. A significant relationship between patient risk profile and benefits from IABP plus ECMO was found in terms of the 30-day mortality (odds ratio [OR] 0.75; 95% confidence interval [CI] 0.62 to 0.91; P = .004) with postcardiotomy shock (PCS). However, ECMO alone was associated with lower in-hospital mortality (OR 1.75; 95% CI 1.06 to 3.01; Z = 2.19; P = .03) compared with ECMO plus IABP without PCS.
Conclusions: Pooled data show that patients receiving IABP plus ECMO with PCS have lower 30-day mortality than those receiving ECMO also, which in turn show higher 30-day mortality in patients with IABP plus ECMO without PCS. Further randomized studies are warranted to corroborate these observational data.
References
Acheampong B, Johnson JN, Stulak JM, et al. 2016. Postcardiotomy ECMO support after high-risk operations in adult congenital heart disease. Congenit Heart Dis 11:751-755.
Agarwal S, Sud K, Martin JM, Menon V. 2015. Trends in the use of mechanical circulatory support devices in patients presenting with ST-segment elevation myocardial infarction. JACC Cardiovasc Interv 8:1772-1774.
Alan G, Chandrasekar P, Aronow WS, et al. 2014. Peripheral venoarterial extracorporeal membrane oxygenation in combination with intra-aortic balloon counterpulsation in patients with cardiovascular compromise. Cardiology 129:137-143.
Altayyar S, Rochwerg B, Alnasser S, et al. 2014. Intra-aortic balloon pump in patients with cardiogenic shock complicating myocardial infarction: A systematic review and meta-analysis of randomized trials (protocol). Syst Rev 3:24.
Ardawan Julian R, Andreas D, Matthias M, et al. 2010. Early and late outcomes of 517 consecutive adult patients treated with extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. J Thorac Cardiovasc Surg 139:302-311.e301.
Aso S, Matsui H, Fushimi K, Yasunaga H. 2016. The effect of intraaortic balloon pumping under venoarterial extracorporeal membrane oxygenation on mortality of cardiogenic patients: An analysis using a nationwide inpatient database. Crit Care Med 44:1974-1979.
Biancari F, DaléN M, Perrotti A, et al. 2017. Venoarterial extracorporeal membrane oxygenation after coronary artery bypass grafting: Results of a multicenter study. Int J Cardiol 241:109-114.
Bréchot N, Demondion P, Santi F, et al. 2017. Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. Eur Heart J Acute Cardiovasc Care 7:62-69.
Brugts JJ, Caliskan K. 2014. Short-term mechanical circulatory support by veno-arterial extracorporeal membrane oxygenation in the management of cardiogenic shock and end-stage heart failure. Exp Rev Cardiovasc Ther 12:145-153.
Burkhoff D, Sayer G, Doshi D, Uriel N. 2015. Hemodynamics of mechanical circulatory support. J Am Coll Cardiol 66:2663-2674.
Cashen K, Thiagarajan RR, Collins JW Jr, et al. 2015. Extracorporeal membrane oxygenation in pediatric trisomy 21: 30 years of experience from the Extracorporeal Life Support Organization Registry. J Pediatr 167:403-408.
Cheng R, Hachamovitch R, Makkar R, et al. 2015. Lack of survival benefit found with use of intraaortic balloon pump in extracorporeal membrane oxygenation: A pooled experience of 1517 patients. J Invas Cardiol 64:453-458.
Chung BB, Sayer G, Uriel N. 2017. Mechanical circulatory support devices: Methods to optimize hemodynamics during use. Expert Ref Med Devices 14:343-353.
Committee for Scientific Affairs, Sakata R, Fujii Y, Kuwano H. 2011. Thoracic and cardiovascular surgery in Japan during 2009: Annual report by the Japanese Association for Thoracic Surgery. Gen Thorac
Cardiovasc Surg 59:636-667.
Doll N, Kiaii B, Borger M, et al. 2004. Five-year results of 219 consecutive patients treated with extracorporeal membrane oxygenation for refractory postoperative cardiogenic shock. Ann Thorac Surg 77:151-157.
Doshi R, Patel K, Decter D, Gupta R, Meraj P. 2018. Trends in the utilisation and in-hospital mortality associated with short-term mechanical circulatory support for heart failure with reduced ejection fraction. Heart Lung Circ 28:e47-e50.
Elsharkawy HA, Li L, Esa WAS, Sessler DI, Bashour CA. 2010.
Outcome in patients who require venoarterial extracorporeal membrane oxygenation support after cardiac surgery. J Cardiothorac Vasc Anesth 24:946-951.
Erwan F, Amedeo A, Hervé C, et al. 2014. Current aspects of extracorporeal membrane oxygenation in a tertiary referral centre: Determinants of survival at follow-up. Eur J Cardiothorac Surg 46:665.
Feilong H, Song L, Jingwen L, et al. 2011. Five-year results of 121 consecutive patients treated with extracorporeal membrane oxygenation at Fu Wai Hospital. Artif Organs 35:572-578.
Gray BW, Haft JW, Hirsch JC, Annich GM, Hirschl RB, Bartlett RH. 2015. Extracorporeal life support: Experience with 2,000 patients. ASAIO J 61:2-7.
Guihaire J, Dang VS, Rouze S, et al. 2017. Clinical outcomes in patients after extracorporeal membrane oxygenation support for post-
cardiotomy cardiogenic shock: A single-centre experience of 92 cases. Interact Cardiovasc Thorac Surg 25:363-369.
Guru P, Sanghavi D, Seelhammer T, Schears G. 2015. Outcome of patients with refractory cardiorespiratory failure managed by combination ECMO and IABP. Crit Care Med 43(12 suppl 1):45.
Guttendorf J, Boujoukos AJ, Ren D, Rosenzweig MQ, Hravnak M. 2014. Discharge outcome in adults treated with extracorporeal membrane oxygenation. Am J Crit Care 23:365-377.
Higgins JP, Thompson SG, Deeks JJ, Altman DG. 2003. Measuring inconsistency in meta-analyses. BMJ 327:557-560.
Hoy FB, Mueller DK, Geiss DM, et al. 2000. Bridge to recovery for postcardiotomy failure: Is there still a role for centrifugal pumps? Ann Thorac Surg 70:1259-1263.
Ingo S, Oliver L, Elmar K, et al. 2013. Outcomes after peripheral extracorporeal membrane oxygenation therapy for postcardiotomy cardiogenic shock: A single-center experience. J Surg Res 181:e47-e55.
Jaski BE, Ortiz B, Alla KR, et al. 2010. A 20-year experience with urgent percutaneous cardiopulmonary bypass for salvage of potential survivors of refractory cardiovascular collapse. J Thorac Cardiovasc Surg 139:753-757.
Jung C, Ferrari M, Gradinger R, et al. 2008. Evaluation of the microcirculation during extracorporeal membrane-oxygenation. Clin Hemorheol Microcirc 40:311-314.
Karl W, Stephan G, Henning E, Hochman JS. 2014. Mechanical circulatory support in cardiogenic shock. Eur Heart J 35:156-167.
Khorsandi M, Dougherty S, Bouamra O, et al. 2017. Extra-corporeal membrane oxygenation for refractory cardiogenic shock after adult cardiac surgery: A systematic review and meta-analysis. J Cardiothorac Surg 12:55.
Khorsandi M, Dougherty S, Sinclair A, et al. 2016. A 20-year multicentre outcome analysis of salvage mechanical circulatory support for refractory cardiogenic shock after cardiac surgery. J Cardiothorac Surg 11:151.
Khorsandi M, Shaikhrezai K, Prasad S, et al. 2015. Advanced mechanical circulatory support for refractory cardiogenic shock after cardiac surgery: An eleven-year experience in Edinburgh. J Cardiothorac Surg 10(suppl 1):A336.
Ko WJ, Lin CY, Chen RJ, Wang SS, Lin FY, Chen YS. 2002. Extracorporeal membrane oxygenation support for adult postcardiotomy cardiogenic shock. Ann Thorac Surg 73:538-545.
Kyun RS, Joon Bum K, Sung Ho J, Suk Jung C, Cheol Hyun C, Jae Won L. 2014. Extracorporeal life support for cardiogenic shock: Influence of concomitant intra-aortic balloon counterpulsation. Eur J Cardiothorac Surg 46:186-192.
Li Y, Yan S, Gao S, et al. 2019 Effect of an intra-aortic balloon pump with venoarterial extracorporeal membrane oxygenation on mortality of patients with cardiogenic shock: A systematic review and meta-analysis. Eur J Cardiothorac Surg 55:395-404
Liberati A, Altman DG, Tetzlaff J, et al. 2009. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. Ann Intern Med 151:W65-W94.
Ma P, Zhang Z, Song T, et al. 2014. Combining ECMO with IABP for the treatment of critically ill adult heart failure patients. Heart Lung Circ 23:363-368.
Magovern GJ, Jr., Magovern JA, Benckart DH, et al. 1994. Extracorporeal membrane oxygenation: Preliminary results in patients with postcardiotomy cardiogenic shock. Ann Thorac Surg 57:1462-1468.
Magovern GJ, Simpson KA. 1999. Extracorporeal membrane oxygenation for adult cardiac support: The Allegheny experience. Ann Thorac Surg 68:655-661.
Mariana M, Charles-Edouard L, Pascal L, et al. 2011. Outcomes, long-term quality of life, and psychologic assessment of fulminant myocarditis patients rescued by mechanical circulatory support. Crit Care Med 39:1029-1035.
Mascio CE, Austin EH, Jacobs JP, et al. 2014. Perioperative mechanical circulatory support in children: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. J Thorac Cardiovasc Surg 147:658-665.
Meani P, Delnoij T, Raffa GM, et al. 2018. Protracted aortic valve closure during peripheral veno-arterial extracorporeal life support: Is intra-aortic balloon pump an effective solution? Perfusion 34:35-41.
Meani P, Gelsomino S, Natour E, et al. 2017. Modalities and effects of left ventricle unloading on extracorporeal life support: A review of the current literature. Eur J Heart Failure 19(suppl 2):84.
Mikus E, Tripodi A, Calvi S, Giglio MD, Cavallucci A, Lamarra M. 2013. CentriMag venoarterial extracorporeal membrane oxygenation support as treatment for patients with refractory postcardiotomy cardiogenic shock. ASAIO J 59:18-23.
Mosier JM, Kelsey M, Raz Y, et al. 2015. Extracorporeal membrane oxygenation (ECMO) for critically ill adults in the emergency department: History, current applications, and future directions. Crit Care 19:431.
Muehrcke DD, Mccarthy PM, Stewart RW, et al. 1996.
Extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock. Ann Thorac Surg 61:684-691.
Muller G, Flecher E, Lebreton G, et al. 2016. The ENCOURAGE mortality risk score and analysis of long-term outcomes after VA-ECMO for acute myocardial infarction with cardiogenic shock. Intensive Care Med 42:370-378.
Musiał R, Darocha T, Kosiński S, Stoliński J, Sadowski J, Drwiła R. 2015. Application of V-A ECMO therapies for short-term mechanical circulatory support in patients with cardiogenic shock. Anaesthesiol Intensive Ther 47:324-327.
Ouyang D, Gulati G, Ha R, Banerjee D. 2018. Incidence of temporary mechanical circulatory support prior to heart transplantation and impact on post-transplant outcomes. J Heart Lung Transplant 37:1060-1066.
Papadopoulos N, Marinos S, Ahmad ES, et al. 2015. Risk factors associated with adverse outcome following extracorporeal life support: Analysis from 360 consecutive patients. Perfusion 30:284-290.
Peigh G, Cavarocchi N, Keith SW, Hirose H. 2015. Simple new risk score model for adult cardiac extracorporeal membrane oxygenation. J Surg Res 198:273-279.
Pfluecke C, Christoph M, Kolschmann S, et al. 2014. Intra-aortic balloon pump (IABP) counterpulsation improves cerebral perfusion in patients with decreased left ventricular function. Perfusion 29:511-516.
Pokersnik JA, Buda T, Bashour CA, Gonzalez-Stawinski GV. 2012. Have changes in ECMO technology impacted outcomes in adult patients developing postcardiotomy cardiogenic shock? J Cardiac Surg 27:246-252.
Raffa GM, Kowalewski M, Brodie D, et al. 2019. Meta-analysis of peripheral or central ECMO in postcardiotomy and non-postcardiotomy shock. Ann Thorac Surg 107:311-321.
Roland P, Henning L, Michael S, et al. 2010. Intra-aortic balloon counterpulsation in patients with acute myocardial infarction complicated by cardiogenic shock: The prospective, randomized IABP SHOCK Trial for attenuation of multiorgan dysfunction syndrome. Crit Care Med 38:152-160.
Ruoyu Z, Theo K, Hiroyuki K, et al. 2006. Creatine kinase isoenzyme MB relative index as predictor of mortality on extracorporeal membrane oxygenation support for postcardiotomy cardiogenic shock in adult patients. Eur J Cardiothorac Surg 30:617-620.
Santarpino G, Ruggieri VG, Mariscalco G, et al. 2015. Outcome in patients having salvage coronary artery bypass grafting. Am J Cardiol 116:1193-1198.
Satoshi U, Akira S, Mitsumasa H, et al. 2013. Long-term outcomes of patients undergoing extracorporeal membrane oxygenation for refractory postcardiotomy cardiogenic shock. Surgery Today 43:264-270.
Saxena P, Neal J, Joyce LD, et al. 2015. Extracorporeal membrane oxygenation support in postcardiotomy elderly patients: The Mayo Clinic experience. Ann Thorac Surg 99:2053-2060.
Scheidt S, Wilner G, Mueller H, et al. 1973. Intra-aortic balloon counterpulsation in cardiogenic-shock: Report of a cooperative clinical trial. N Engl J Med 288:979-984.
Smedira NG, Blackstone EH. 2001. Postcardiotomy mechanical support: Risk factors and outcomes. Ann Thorac Surg 71:S60-S66.
Stroup DF, Berlin JA, Morton SC, et al. 2000. Meta-analysis of observational studies in epidemiology: A proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008-2012.
Thiele H, Zeymer U, Neumann FJ, et al. 2013. Intra-aortic balloon counterpulsation in acute myocardial infarction complicated by cardiogenic shock (IABP-SHOCK II): Final 12 month results of a randomised, open-label trial. Lancet 382:1638-1645.
Thiele H, Zeymer U, Neumann FJ, et al. 2012. Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med 367:1287-1296.
Toshifumi M, Kazuhiro E, Tsukasa M, et al. 2015. Outcome of the perioperative use of percutaneous cardiopulmonary support for adult cardiac surgery: Factors affecting hospital mortality. Artif Organs 28:189-195.
Vallabhajosyula S, O’Horo JC, Antharam P, et al. 2018 Concomitant intra-aortic balloon pump use in cardiogenic shock requiring veno-
arterial extracorporeal membrane oxygenation. Circ Cardiovasc Intervent 11:e006930.
Viechtbauer W. 2010. Conducting meta-Analyses in R with the metafor package. J Stat Softw 36:1-48.
Wang JG, Han J, Jia YX, Zeng W, Hou XT, Meng X. 2013. Outcome of veno-arterial extracorporeal membrane oxygenation for patients undergoing valvular surgery. PloS One 8:e63924.
Wang L, Wang H, Hou X. 2018. Clinical outcomes of adult patients receiving extracorporeal membrane oxygenation for postcardiotomy cardiogenic shock: A systematic review and meta-analysis. J Cardiothorac Vasc Anesth 32:2087-2093.
Williams DO, Korr KS, Gewirtz H, Most AS. 1982. The effect of intraaortic balloon counterpulsation on regional myocardial blood flow and oxygen consumption in the presence of coronary artery stenosis in patients with unstable angina. Circulation 66:593-597.
Xiaolei Y, Shijie J, Xu M, et al. 2010. Acute kidney injury in adult postcardiotomy patients with extracorporeal membrane oxygenation: Evaluation of the RIFLE classification and the Acute Kidney Injury Network criteria. Eur J Cardiothorac Surg 37:334-338.
Xie HX, Yang F, Jiang CJ, et al. 2017. [Predictors of in-hospital mortality in adult postcardiotomy cardiacgenic shock patients successfully weaned from venoarterial extracorporeal membrane oxygenation]. Zhonghua Yi Xue Za Zhi 97:929. In Chinese.
Yang F, Hou D, Wang J, et al. 2018. Vascular complications in adult postcardiotomy cardiogenic shock patients receiving venoarterial extracorporeal membrane oxygenation. Ann Intens Care 8:72.
Yih-Sharng C, Jou-Wei L, Hsi-Yu Y, et al. 2008. Cardiopulmonary resuscitation with assisted extracorporeal life-support versus conventional cardiopulmonary resuscitation in adults with in-hospital cardiac arrest: An observational study and propensity analysis. Lancet 372:554-561.
