在VA-ECMO患者中使用Impella对IABP进行左心室卸载:系统性审查和元分析
Kruti D Gandhi1, Errol C Moras1, Shailesh Niroula2
1Department of Internal Medicine, Mount Sinai Morningside/West, New York, New York.
The American journal of cardiology
|October 9, 2023
概括
用Impella或大动脉内气球 (IABP) 进行静脉外体膜氧化 (VA-ECMO) 显示,心脏性休克患者的短期死亡率相似. 然而,使用Impella会增加重大出血和血液溶解的风险.
科学领域:
- 心脏病学 心脏病学
- 临界护理医学 临界护理医学
- 医疗器械 医疗器械
背景情况:
- 静脉外体膜氧化 (VA-ECMO) 对于心脏性休克增加左心室 (LV) 后负荷.
- 在VA-ECMO期间,Impella和大动脉内气球 (IABP) 是LV卸载的辅助设备.
- 对这些LV卸载策略的比较有效性和安全性数据至关重要.
研究的目的:
- 为了比较Impella与IABP在VA-ECMO患者的LV卸载中的有效性和安全性.
- 分析住院死亡率的初级结果和二级结果,包括器件过渡,中风,四肢缺血症,脏替代疗法,出血和血液溶解.
主要方法:
- 对Medline,EMBASE和Cochrane数据库进行系统的文献搜索.
- 包括7项观察性研究,包括698名VA-ECMO.患者.
- 随机效应元分析以计算聚合风险比率 (RRs) 和异质性 (I2).
主要成果:
- 在Impella和IABP组之间可比的短期全因死亡率 (30天或住院) (60.8%vs64.9%).
- 在过渡到持久的LV辅助器件/心脏移植,RRT启动,中风或肢体缺血方面没有显著差异.
- 使用Impella与严重出血 (57.2%对39.7%) 和血液溶解 (31%对7%) 的风险显著增加.
结论:
- 与VA-ECMO同时使用Impella或IABP会导致类似的心脏病性休克的短期死亡率.
- 与IABP相比,在VA-ECMO期间使用Impella与严重出血和血液溶解的风险增加有关.
- 在选择使用VA-ECMO的LV卸载策略时,需要仔细考虑出血和血液溶解风险.
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