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Mechanical circulatory support for life-threatening arrhythmia: A systematic review
Silvia Mariani1, L Christian Napp2, Valeria Lo Coco3
1Department of Cardiothoracic, Transplantation and Vascular, Surgery, Hannover Medical School, Hannover, Germany.
International Journal of Cardiology
|April 2, 2020
Summary
Prophylactic temporary mechanical circulatory support (tMCS) improves survival in patients with life-threatening arrhythmias, especially those at high risk or experiencing electrical storms. Rescue tMCS shows significantly higher mortality rates.
Area of Science:
- Cardiology
- Critical Care Medicine
- Electrophysiology
Background:
- Temporary mechanical circulatory support (tMCS) use is rising for arrhythmias, but evidence on optimal timing, management, and configuration is limited.
- Significant knowledge gaps exist regarding the application of tMCS in managing life-threatening arrhythmias.
Purpose of the Study:
- To systematically review and analyze the use of tMCS in patients experiencing life-threatening arrhythmias.
- To evaluate the effectiveness and outcomes associated with tMCS in this patient population.
Main Methods:
- A systematic literature search identified 2529 references up to September 2019.
- Included adult and pediatric patients with life-threatening arrhythmias, comparing tMCS to conventional therapies.
- Primary outcome was in-hospital or 30-day mortality.
Main Results:
- 19 non-randomized studies with 2465 adults and 82 pediatric patients were analyzed.
- Prophylactic tMCS showed lower mortality (4-21%) compared to rescue tMCS (58-62%).
- High-risk patients (PAINESD score, electrical storm) treated with prophylactic tMCS demonstrated a substantial survival benefit. ECMO in pediatric cases showed >80% survival.
Conclusions:
- Prophylactic tMCS is linked to improved survival in life-threatening arrhythmias compared to rescue or no-tMCS.
- Consider prophylactic tMCS for high-risk patients or those with electrical storms.
- Extracorporeal membrane oxygenation (ECMO) is a viable rescue and support therapy for pediatric cases needing aggressive antiarrhythmic treatment.
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