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Meta-Analysis
. 2022 Apr;15(2):227-238.
doi: 10.1007/s12265-021-10140-w. Epub 2021 Jun 3.

Predictors of Mortality in Patients Treated with Veno-Arterial ECMO for Cardiogenic Shock Complicating Acute Myocardial Infarction: a Systematic Review and Meta-Analysis

Shahmir Sohail  1   2   3 , Eddy Fan  4   5 , Farid Foroutan  6   7   4 , Heather J Ross  6   7   4 , Filio Billia  6   7   4 , Ana Carolina Alba  6   7   4
Affiliations
Meta-Analysis

Predictors of Mortality in Patients Treated with Veno-Arterial ECMO for Cardiogenic Shock Complicating Acute Myocardial Infarction: a Systematic Review and Meta-Analysis

Shahmir Sohail et al. J Cardiovasc Transl Res. 2022 Apr.

Abstract

Background: Mortality for patients on veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for cardiogenic shock (CS) complicating acute myocardial infarction (AMI) remains high. This meta-analysis aims to identify factors that predict higher risk of mortality after VA-ECMO for AMI.

Methods: We meta-analyzed mortality after VA-ECMO for CS complicating AMI and the effect of factors from systematically selected studies published after 2009.

Results: 72 studies (10,276 patients) were included with a pooled mortality estimate of 58 %. With high confidence in estimates, failure to achieve TIMI III flow and left main culprit were identified as factors associated with higher mortality. With low-moderate confidence, older age, high BMI, renal dysfunction, increasing lactate, prothrombin activity < 50%, VA-ECMO implantation after revascularization, and non-shockable ventricular arrythmias were identified as factors associated with mortality.

Conclusion: These results provide clinicians with a framework for selecting patients for VA-ECMO for CS complicating AMI.

Keywords: Cardiogenic shock; Mortality; Myocardial infarction; VA-ECMO.

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References

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