Affas Ziad R, Touza Ghaid G, Affas Saif
Internal Medicine, Henry Ford Macomb Hospital, Clinton Township, USA.
Internal Medicine, Hawler Medical University, Erbil, IRQ.
Cureus. 2021 Nov 16;13(11):e19622. doi: 10.7759/cureus.19622. eCollection 2021 Nov.
The right ventricular complication happens when the right ventricle (RV) fails to move sufficient blood through the pulmonary circle to enable enough left ventricular pumping. A significant pulmonary embolism/right-sided myocardial infarction may cause this to develop suddenly in a previously healthy heart, but many of the patients treated in the critical care unit have gradual, compensated RV failure as a result of chronic heart and lung disease. RV failure management aims to decrease afterload and improve right-side filling pressures. Vasoactive medications have a lower effect on lowering vascular obstruction in the pulmonary circulation than in the systemic circle because the vascular tone is lower in the pulmonary circulation. Any factors that induce an elevation in pulmonary vascular tone must be addressed, and selective pulmonary vasodilators must be administered in a prescription that does not result in systemic hypotension or compromise oxygenation. The system-based systolic arterial pressure should be kept near the RV systolic pressure to ensure RV perfusion. When these efforts prove futile, judicious application of inotropic medications for better RV contractility may help ensure cardiac output. After obtaining the finest medical treatment, certain individuals may need the implantation of a mechanical circulatory support device. This meta-analysis is intended to compare the Impella and venoarterial (VA) extracorporeal membrane oxygenation (ECMO) mechanical supports for patients with acute right ventricular failure. This comparison should demonstrate the best mechanical support between the two through thorough analysis. The analysis was begun by data collection from relevant sites; PUBMED and EMBASE were searched in collaboration with Google Scholar. Keywords were searched: Impella for acute right ventricle failure and VA ECMO for acute right ventricle failure. The results that were close to the search titles had their respective articles downloaded for further scrutiny. The search finally brought 1001 related articles that were exposed to further analysis to find more refined and closer articles within the needs of this meta-analysis. After extensive scrutiny, 23 articles were found to be the best for these analyses. The data showed that VA ECMO had better results than Impella for acute RV failure. However, the data were not statistically significant, as either the numbers of the studies were not enough or the null hypothesis was true and there was no true difference between them. More studies will be needed to confirm this.
当右心室无法将足够的血液泵入肺循环以维持左心室的有效泵血时，就会发生右心室并发症。严重的肺栓塞或右心室心肌梗死可能会使原本健康的心脏突然出现这种情况，但在重症监护病房接受治疗的许多患者由于慢性心肺疾病而逐渐出现代偿性右心室衰竭。右心室衰竭的治疗旨在降低后负荷并改善右心室充盈压。血管活性药物对降低肺循环中血管阻塞的作用比对体循环的作用小，因为肺循环中的血管张力较低。任何导致肺血管张力升高的因素都必须得到解决，并且必须使用不会导致系统性低血压或影响氧合的选择性肺血管扩张剂。基于系统的收缩期动脉压应保持在接近右心室收缩压的水平，以确保右心室灌注。当这些措施无效时，明智地使用强心药物以增强右心室收缩力可能有助于确保心输出量。在获得最佳药物治疗后，某些患者可能需要植入机械循环支持装置。这项荟萃分析旨在比较Impella和静脉-动脉（VA）体外膜肺氧合（ECMO）对急性右心室衰竭患者的机械支持效果。通过全面分析，此次比较应能显示两者之间哪种机械支持效果最佳。分析首先从相关网站收集数据；与谷歌学术合作检索了PUBMED和EMBASE。搜索关键词为：用于急性右心室衰竭的Impella和用于急性右心室衰竭的VA ECMO。与搜索标题相近的结果下载了各自的文章以供进一步审查。此次搜索最终带来了1001篇相关文章，对这些文章进行进一步分析，以在本次荟萃分析的需求范围内找到更精确和更接近的文章。经过广泛审查，发现23篇文章最适合这些分析。数据显示，对于急性右心室衰竭，VA ECMO的效果优于Impella。然而，这些数据在统计学上并不显著，原因可能是研究数量不足，或者原假设成立，两者之间没有真正的差异。需要更多的研究来证实这一点。
