Venoarterial extracorporeal membrane oxygenation in patients with infarct-related cardiogenic shock: an individual patient data meta-analysis of randomised trials
Language English Country England, Great Britain Media print-electronic
Document type Meta-Analysis, Journal Article, Research Support, Non-U.S. Gov't, Comment
PubMed
37643628
DOI
10.1016/s0140-6736(23)01607-0
PII: S0140-6736(23)01607-0
Knihovny.cz E-resources
- MeSH
- Intra-Aortic Balloon Pumping MeSH
- Shock, Cardiogenic * etiology therapy MeSH
- Hemorrhage etiology MeSH
- Humans MeSH
- Logistic Models MeSH
- Extracorporeal Membrane Oxygenation * adverse effects MeSH
- Randomized Controlled Trials as Topic MeSH
- Retrospective Studies MeSH
- Check Tag
- Humans MeSH
- Publication type
- Journal Article MeSH
- Comment MeSH
- Meta-Analysis MeSH
- Research Support, Non-U.S. Gov't MeSH
BACKGROUND: Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is increasingly used in patients with cardiogenic shock despite the lack of evidence from adequately powered randomised clinical trials. Three trials reported so far were underpowered to detect a survival benefit; we therefore conducted an individual patient-based meta-analysis to assess the effect of VA-ECMO on 30-day death rate. METHODS: Randomised clinical trials comparing early routine use of VA-ECMO versus optimal medical therapy alone in patients presenting with infarct-related cardiogenic shock were identified by searching MEDLINE, Cochrane Central Register of Controlled Trials, Embase, and trial registries until June 12, 2023. Trials were included if at least all-cause death rate 30 days after in-hospital randomisation was reported and trial investigators agreed to collaborate (ie, providing individual patient data). Odds ratios (ORs) as primary outcome measure were pooled using logistic regression models. This study is registered with PROSPERO (CRD42023431258). FINDINGS: Four trials (n=567 patients; 284 VA-ECMO, 283 control) were identified and included. Overall, there was no significant reduction of 30-day death rate with the early use of VA-ECMO (OR 0·93; 95% CI 0·66-1·29). Complication rates were higher with VA-ECMO for major bleeding (OR 2·44; 95% CI 1·55-3·84) and peripheral ischaemic vascular complications (OR 3·53; 95% CI 1·70-7·34). Prespecified subgroup analyses were consistent and did not show any benefit for VA-ECMO (pinteraction ≥0·079). INTERPRETATION: VA-ECMO did not reduce 30-day death rate compared with medical therapy alone in patients with infarct-related cardiogenic shock, and an increase in major bleeding and vascular complications was observed. A careful review of the indication for VA-ECMO in this setting is warranted. FUNDING: Foundation Institut für Herzinfarktforschung.
Glenfield Hospital University Hospitals of Leicester NHS Trust Leicester UK
Heart Center Leipzig at University of Leipzig and Leipzig Heart Science Leipzig Germany
Institut für Herzinfarktforschung Ludwigshafen Germany; Klinikum Ludwigshafen Ludwigshafen Germany
Klinikum Ludwigshafen Ludwigshafen Germany
KU Leuven Department of Public Health and Primary Care 1 BioStat Leuven and UHasselt Hasselt Belgium
Norwich Medical School University of East Anglia Norwich UK
University Medical Centre Mannheim Medical Faculty Mannheim Heidelberg University Mannheim Germany
References provided by Crossref.org
Machine learning-based scoring system to predict cardiogenic shock in acute coronary syndrome
What is cardiogenic shock? New clinical criteria urgently needed
Hemodynamic management of cardiogenic shock in the intensive care unit
De senectute and the art of medicine: how old is too old for ECMO in cardiogenic shock?
Growing Evidence for LV Unloading in VA ECMO
