Department of Cardiovascular Medicine (Saraschandra Vallabhajosyula, S.A., Saarwaani Vallabhajosyula, M.F.E., S.M.D., B.J.G., C.S.R., G.W.B.), Mayo Clinic, Rochester, MN.
Division of Pulmonary and Critical Care Medicine, Department of Medicine (Saraschandra Vallabhajosyula, J.C.O.H., P.A.), Mayo Clinic, Rochester, MN.
Circ Cardiovasc Interv. 2018 Sep;11(9):e006930. doi: 10.1161/CIRCINTERVENTIONS.118.006930.
There are contrasting reports on the effectiveness of a concomitant intra-aortic balloon pump (IABP) in cardiogenic shock patients treated with veno-arterial extracorporeal membrane oxygenation (VA-ECMO). This study sought to compare short-term mortality in patients with cardiogenic shock treated with VA-ECMO with and without IABP.
We reviewed the published literature from 2000 to 2018 for studies evaluating adult patients requiring VA-ECMO for cardiogenic shock with concomitant IABP. Studies reporting short-term mortality were included. Meta-analysis of the association of IABP with mortality was performed using Mantel-Haenszel models. Subgroup analyses were performed in patients with cardiogenic shock complicating acute myocardial infarction (AMI) and postcardiotomy cardiogenic shock. Twenty-two observational studies with 4653 patients were included. These studies showed high heterogeneity for the total and postcardiotomy cardiogenic shock cohorts and low heterogeneity for the AMI cohort. Short-term mortality was not significantly different in patients with and without IABP 42.1% versus 57.8%; risk ratio, 0.80; 95% CI, 0.52-1.22; P=0.30. However, concomitant IABP with VA-ECMO was associated with lower mortality in patients with AMI (50.8% versus 62.4%; risk ratio, 0.56; 95% CI, 0.46-0.67; P<0.001). There was no difference in mortality in postcardiotomy cardiogenic shock and mixed causes for cardiogenic shock.
In cardiogenic shock patients requiring VA-ECMO support, the use of IABP did not influence mortality in the total cohort. In patients with AMI, use of IABP with VA-ECMO was associated with 18.5% lower mortality in comparison to patients on VA-ECMO alone. Further randomized studies are warranted to corroborate these observational data.
在接受静脉-动脉体外膜肺氧合（VA-ECMO）治疗的心源性休克患者中，同时使用主动脉内球囊泵（IABP）的效果存在相互矛盾的报告。本研究旨在比较接受 VA-ECMO 治疗的心源性休克患者同时使用和不使用 IABP 的短期死亡率。
我们检索了 2000 年至 2018 年期间评估因心源性休克而接受 VA-ECMO 治疗且同时使用 IABP 的成年患者的文献。纳入报告短期死亡率的研究。使用 Mantel-Haenszel 模型对 IABP 与死亡率的相关性进行荟萃分析。在并发急性心肌梗死（AMI）的心源性休克和心脏手术后的心源性休克患者中进行亚组分析。共纳入 22 项观察性研究，共 4653 例患者。这些研究显示，总体和心脏手术后的心源性休克队列存在高度异质性，而 AMI 队列的异质性较低。有和没有 IABP 的患者短期死亡率分别为 42.1%和 57.8%；风险比为 0.80；95%置信区间为 0.52-1.22；P=0.30。然而，在 AMI 患者中，VA-ECMO 联合 IABP 与较低的死亡率相关（50.8%比 62.4%；风险比为 0.56；95%置信区间为 0.46-0.67；P<0.001）。在心脏手术后的心源性休克和混合原因的心源性休克患者中，死亡率没有差异。
在需要 VA-ECMO 支持的心源性休克患者中，使用 IABP 对总队列的死亡率没有影响。在 AMI 患者中，与单独使用 VA-ECMO 相比，VA-ECMO 联合 IABP 可使死亡率降低 18.5%。需要进一步的随机研究来证实这些观察数据。
