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Meta-Analysis
. 2018 Sep;11(9):e006930.
doi: 10.1161/CIRCINTERVENTIONS.118.006930.

Concomitant Intra-Aortic Balloon Pump Use in Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

Saraschandra Vallabhajosyula  1   2 , John C O'Horo  2   3 , Phanindra Antharam  2 , Sindhura Ananthaneni  1 , Saarwaani Vallabhajosyula  1 , John M Stulak  4 , Mackram F Eleid  1 , Shannon M Dunlay  1 , Bernard J Gersh  1 , Charanjit S Rihal  1 , Gregory W Barsness  1
Affiliations
Meta-Analysis

Concomitant Intra-Aortic Balloon Pump Use in Cardiogenic Shock Requiring Veno-Arterial Extracorporeal Membrane Oxygenation

Saraschandra Vallabhajosyula et al. Circ Cardiovasc Interv. 2018 Sep.

Abstract

Background: There are contrasting reports on the effectiveness of a concomitant intra-aortic balloon pump (IABP) in cardiogenic shock patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This study sought to compare short-term mortality in patients with cardiogenic shock treated with VA-ECMO with and without IABP.

Methods and results: We reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring VA-ECMO for cardiogenic shock with concomitant IABP. Studies reporting short-term mortality were included. Meta-analysis of the association of IABP with mortality was performed using Mantel-Haenszel models. Subgroup analyses were performed in patients with cardiogenic shock complicating acute myocardial infarction (AMI) and postcardiotomy cardiogenic shock. Twenty-two observational studies with 4653 patients were included. These studies showed high heterogeneity for the total and postcardiotomy cardiogenic shock cohorts and low heterogeneity for the AMI cohort. Short-term mortality was not significantly different in patients with and without IABP 42.1% versus 57.8%; risk ratio, 0.80; 95% CI, 0.52-1.22; P=0.30. However, concomitant IABP with VA-ECMO was associated with lower mortality in patients with AMI (50.8% versus 62.4%; risk ratio, 0.56; 95% CI, 0.46-0.67; P<0.001). There was no difference in mortality in postcardiotomy cardiogenic shock and mixed causes for cardiogenic shock.

Conclusions: In cardiogenic shock patients requiring VA-ECMO support, the use of IABP did not influence mortality in the total cohort. In patients with AMI, use of IABP with VA-ECMO was associated with 18.5% lower mortality in comparison to patients on VA-ECMO alone. Further randomized studies are warranted to corroborate these observational data.

Keywords: extracorporeal membrane oxygenation; intra-aortic balloon pumping; myocardial infarction; patients; risk.

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Comment in

  • Left Ventricular Support.
    Marquis-Gravel G, Ohman EM. Marquis-Gravel G, et al. Circ Cardiovasc Interv. 2018 Sep;11(9):e007214. doi: 10.1161/CIRCINTERVENTIONS.118.007214. Circ Cardiovasc Interv. 2018. PMID: 30354607 No abstract available.

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