Hemoadsorption in Heart Failure Requiring Mechanical Circulatory Support-A Systematic Review and Meta-Analysis

Area of Science:

• Cardiology
• Critical Care Medicine
• Biomedical Engineering

Background:

• Mechanical circulatory support devices like LVADs and ECMO are vital for heart failure (HF).
• These devices can exacerbate inflammation, a known risk factor in HF patients.
• Hemoadsorption is explored to mitigate this inflammation during procedures.

Purpose of the Study:

• To evaluate the efficacy of hemoadsorption in patients with acute or chronic heart failure.
• To assess its impact on survival when used with mechanical circulatory support (LVAD, ECMO).

Main Methods:

• Systematic literature search of MEDLINE for studies comparing hemoadsorption with standard care during LVAD implantation or VA-ECMO.
• Studies were screened by two independent investigators.
• Exclusion of reports without control groups and duplicate entries.

Main Results:

• Six studies were included: one randomized and five retrospective.
• For LVADs, one study showed no mortality difference but increased respiratory issues; another found higher mortality with hemoadsorption.
• For ECMO, most studies found no difference in survival or adverse events; one small study reported lower mortality with hemoadsorption.

Conclusions:

• Hemoadsorption during LVAD implantation may be linked to increased morbidity and mortality.
• During VA-ECMO, hemoadsorption generally showed no impact on mortality or organ dysfunction.
• Limited by small sample sizes and retrospective designs, findings suggest cautious use of hemoadsorption in these settings.