Effect of veno-arterial extracorporeal membrane oxygenation combined with intra-aortic balloon pumping on mortality in patients with cardiogenic diseases: a meta-analysis

doi:10.3877/cma.j.issn.1674-6880.2023.01.009

Abstract

Abstract:

Objective

To systematically evaluate the effect of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) combined with intra-aortic balloon pumping (IABP) on the mortality of patients with cardiogenic diseases.

Methods

Systematic searches were conducted in PubMed, the Cochrane Library, Embase, Web of Science, Wanfang data, CNKI and CBM to collect articles about using VA-ECMO combined with IABP to treat patients with cardiogenic diseases published up to April 2022. Two reviewers independently screened articles, extracted data and evaluated quality, and then the meta-analysis was performed using Stata 17 software.

Results

A total of 15 528 patients were enrolled in 84 studies, of which 8 520 patients received VA-ECMO combined with IABP (experimental group) and 7 008 patients only received VA-ECMO (control group). Meta-analysis showed that as compared with the control group, the 30-d mortality/inpatient mortality [relative risk (RR) = 0.86, 95% confidence interval (CI) (0.83, 0.89), Z = 8.64, P < 0.000 01] and the incidence of neurological complications [RR = 0.70, 95%CI (0.54, 0.90), Z = 2.78, P = 0.005] decreased remarkably, and the success rate of weaning from ECMO [RR = 1.35, 95%CI (1.28, 1.42), Z = 11.89, P < 0.000 01] increased obviously in the experimental group. Subgroup analysis showed that the 30-d mortality/inpatient mortality in patients with heart-related mixed diseases [RR = 0.85, 95%CI (0.81, 0.90), Z = 5.99, P < 0.000 01] and in patients with acute coronary syndrome (ACS) [RR = 0.68, 95%CI (0.63, 0.74), Z = 9.21, P < 0.000 01] and the incidence of mixed neurological complications [RR = 0.58, 95%CI (0.40, 0.84), Z = 2.90, P = 0.004] were much lower, and the success rate of weaning from ECMO in patients with postcardiotomy [RR = 1.22, 95%CI (1.10, 1.34), Z = 3.88, P = 0.000 1] and heart-related mixed diseases [RR = 1.45, 95%CI (1.37, 1.53), Z = 12.51, P < 0.000 01] were much higher in the experimental group than those in the control group.

Conclusion

Compared with VA-ECMO alone, VA-ECMO combined with IABP can reduce 30-d mortality/inpatient mortality in patients with heart-related mixed diseases and ACS, increase the success rate of weaning from ECMO in patients with postcardiotomy and heart-related mixed diseases, and reduce mixed neurological complications.

Key words: Extracorporeal membrane oxygenation, Intra-aortic balloon pumping, Mortality, Cardiogenic disease, Meta-analysis

Jing Chen, Yang Yao, Jirong Miao, Ge Ding, Qing Ma, Yimeng Peng, Zhou Lu, Fenger Kang, Shengyu Wang. Effect of veno-arterial extracorporeal membrane oxygenation combined with intra-aortic balloon pumping on mortality in patients with cardiogenic diseases: a meta-analysis[J]. Chinese Journal of Critical Care Medicine(Electronic Edition), 2023, 16(01): 48-59.

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References 104

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