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Meta-Analysis
. 2025 Apr;49(4):556-570.
doi: 10.1111/aor.14898. Epub 2024 Nov 4.

Early left ventricular unloading during extracorporeal membrane oxygenation in cardiogenic shock: A systematic review and meta-analysis

Mohamed Abuelazm  1 , Ahmad Nawlo  2 , Ahmed A Ibrahim  3 , Ahmed Mazen Amin  4 , Abdelrahman Mahmoud  5 , Salem Elshenawy  6 , Yasmeen Jamal Alabdallat  7 , Mustafa Turkmani  8   9 , Basel Abdelazeem  10 , Marco Caccamo  10
Affiliations
Meta-Analysis

Early left ventricular unloading during extracorporeal membrane oxygenation in cardiogenic shock: A systematic review and meta-analysis

Mohamed Abuelazm et al. Artif Organs. 2025 Apr.

Abstract

Background: Left ventricular (LV) unloading is a crucial intervention to decrease the harmful consequences of extracorporeal membrane oxygenation (ECMO) on hemodynamic status in cardiogenic shock (CS) patients. However, a lingering question preoccupies experts: Should we intervene early or wait until clinical deterioration caused by increasing afterload is detected?

Methods: A systematic review and meta-analysis synthesizing studies, which were retrieved by systematically searching PubMed, Web of Science, SCOPUS, and Cochrane through December 2023. We used R V. 4.3 to pool dichotomous data using risk ratio (RR) and continuous data using mean difference (MD) with a 95% confidence interval (CI).

Prospero id: CRD42024501643.

Results: Eight studies with 2.117 patients were included. Early/prophylactic LV unloading was associated with a lower incidence of all-cause mortality [RR: 0.87 with 95% CI (0.79, 0.95), p < 0.01]. However, there was no significant difference between the two groups regarding cardiac mortality [RR: 1.01 with 95% CI (0.68, 1.48), p = 0.98], non-cardiac mortality [RR: 0.86 with 95% CI (0.46, 1.62), p = 0.64], and in-hospital mortality [RR: 0.95 with 95% CI (0.86, 1.05), p = 0.30]. There was no significant difference between the two groups regarding ECMO weaning, myocardial recovery, ECMO duration, and length of hospitalization.

Conclusion: Early/prophylactic LV unloading during ECMO for CS patients was associated with a decreased incidence of all-cause mortality and sepsis or infection, with no effect on ECMO weaning, myocardial recovery, ECMO duration, and hospital length of stay.

Keywords: ECMO; LV unloading; clinical trial; meta‐analysis; review; shock.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

FIGURE 1
FIGURE 1
PRISMA flow chart of the screening process. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 2
FIGURE 2
Quality assessment of risk of bias in the included studies. (A) ROB‐2 assessment of randomized controlled trials. (B) ROBINS‐I assessment of observational studies. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 3
FIGURE 3
Forest plot of the primary efficacy outcome (mortality). CI, confidence interval; RR, risk ratio. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 4
FIGURE 4
Forest plot of the secondary efficacy outcomes, RR: risk ratio; MD: mean difference; CI: Confidence interval. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 5
FIGURE 5
Forest plot of the complications (A). CI, confidence interval; RR, risk ratio. [Color figure can be viewed at wileyonlinelibrary.com]
FIGURE 6
FIGURE 6
Forest plot of the complications (B). CI, confidence interval; RR, risk ratio. [Color figure can be viewed at wileyonlinelibrary.com]
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