Left ventricular unloading with Impella versus IABP in patients on VA-ECMO for cardiogenic shock

Abstract Background Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) use for circulatory support in shock is limited by increased left ventricular afterload. Impella and intra-aortic balloon pump (IABP) can be used conjunction with VA-ECMO to help unload the ventricle. Data comparing two strategies are limited. Purpose We performed a systematic review meta-analysis of published data compare outcomes patients supported versus IABP. Methods conducted search Medline, Embase, Cochrane databases identify studies IABP on VA-ECMO. The primary outcome interest was all-cause mortality (in-hospital or 30-day). Secondary included transition destination therapy assist device (LVAD) transplant, stroke, need continuous renal replacement (CRRT), bleeding, hemolysis. Risk ratios (RR) 95% confidence interval heterogeneity statistic I2 were reported each outcome. Results Six observational total 629 analysis. Of these, 205 (33%) 424 (67%) respectively, addition All six No difference observed between (RR 1.02 [0.74–1.40], I2=74%). Similar rates LVAD transplant 0.75 [0.45–1.27], I2=0%), stroke 1.50 [0.80–2.83], CRRT 1.04 [0.82–1.32], I2=0%). However, associated higher risk bleeding 1.91 [1.28–2.86], I2=68%) hemolysis 4.61 [1.24–17.17], I2=66%) as compared Conclusion In requiring VA-ECMO, concurrent had similar mortality, LVAD/transplant, CRRT. Randomized trials needed optimal strategy unloading cardiogenic Funding Acknowledgement Type funding sources: None.