Zhang Han, Wang Tianlong, Wang Jing, Liu Gang, Yan Shujie, Teng Yuan, Wang Jian, Ji Bingyang
Department of Cardiopulmonary Bypass, National Center for Cardiovascular Disease, Chinese Academy of Medical Sciences & Peking Union Medical College, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Beijing, China.
Int J Cardiol Heart Vasc. 2024 Sep 4;54:101506. doi: 10.1016/j.ijcha.2024.101506. eCollection 2024 Oct.
Left ventricular (LV) overload is a frequent complication during VA-ECMO associated with poor outcomes. Many strategies of LV unloading have been documented but lack of evidence shows which is better. We conducted a network meta-analysis to compare different LV unloading strategies.
We searched databases for all published studies on LV unloading strategies during VA-ECMO. The pre-defined primary outcome was all-cause mortality.
45 observational studies (34235 patients) were included. The Surface Under the Cumulative Ranking values (SUCRA) demonstrated that compared to no unloading strategy (15.4 %), IABP (73.8 %), pLVAD (60.8 %), atrial septostomy (51.2 %), catheter venting (48.8 %) were all associated with decreased all-cause mortality, in which IABP and pLVAD existed statistical significance. For secondary outcomes, no unloading group had the shortest VA-ECMO duration, ICU and hospital length of stay, and the lower risk of complications compared with unloading strategies. IABP was associated with reducing VA-ECMO duration, ICU and hospital length of stay, and the risk of complications (except for hemolysis as the second best) compared with other unloading strategies.
LV unloading strategies during VA-ECMO were associated with improved survival compared to no unloading, but the tendency to increase the risk of various complications deserves more consideration.
左心室（LV）负荷过重是体外膜肺氧合（VA-ECMO）期间常见的并发症，与不良预后相关。许多左心室减负策略已有文献记载，但缺乏证据表明哪种策略更好。我们进行了一项网状荟萃分析，以比较不同的左心室减负策略。
我们在数据库中检索了所有已发表的关于VA-ECMO期间左心室减负策略的研究。预先定义的主要结局是全因死亡率。
纳入了45项观察性研究（34235例患者）。累积排序曲线下面积值（SUCRA）表明，与无减负策略（15.4%）相比，主动脉内球囊反搏（IABP，73.8%）、经皮左心室辅助装置（pLVAD，60.8%）、房间隔造口术（51.2%）、导管排气（48.8%）均与全因死亡率降低相关，其中IABP和pLVAD具有统计学意义。对于次要结局，与减负策略相比，无减负组的VA-ECMO持续时间、重症监护病房（ICU）和住院时间最短，并发症风险较低。与其他减负策略相比，IABP与缩短VA-ECMO持续时间、ICU和住院时间以及降低并发症风险相关（溶血除外，溶血是第二好的）。
与无减负相比，VA-ECMO期间的左心室减负策略与生存率提高相关，但增加各种并发症风险的趋势值得更多关注。
