成人心源性休克中使用和不使用主动脉内球囊反搏的静脉-动脉体外膜肺氧合的疗效
Efficacy of venoarterial extracorporeal membrane oxygenation with and without intra-aortic balloon pump in adult cardiogenic shock.
作者信息
Wang Haiwang, Li Chuanlong, Li Duo, Chen Yuansen, Li Wenli, Liu Yanqing, Li Yongnan, Fan Haojun, Hou Shike
机构信息
Institute of Disaster and Emergency Medicine, Tianjin University, Tianjin, China.
Wenzhou Safety (Emergency) Institute, Tianjin University, Wenzhou, China.
出版信息
Front Cardiovasc Med. 2024 Sep 6;11:1431875. doi: 10.3389/fcvm.2024.1431875. eCollection 2024.
INTRODUCTION
Intra-aortic balloon pump (IABP) is sometimes coupled with Venoarterial extracorporeal membrane oxygenation (VA-ECMO) to treat patients with cardiogenic shock. In this study, we attempted to evaluate the association of the IABP approach on survival and vascular complication rates in adults with cardiogenic shock undergoing VA-ECMO.
METHODS
We performed a systematic search of original studies on VA-ECMO with and without IABP in PubMed, EMBASE, and the Cochrane Library.
RESULTS
A total of 42 studies with 8,759 patients were included. The pooled in-hospital deaths of patients on VA-ECMO with and without IABP were 2,962/4,807 (61.61%) versus 2,666/3,952 (67.45%). VA-ECMO with IABP presents lower in-hospital mortality (risk ratio, 0.88; 95% CI, 0.86-0.91; < 0.00001). In addition, IABP was associated with lower in-hospital mortality of patients with postcardiotomy cardiogenic shock and ischaemic heart disease. (risk ratio, 0.93; 95% CI, 0.87-0.98; = 0.01; risk ratio, 0.85; 95% CI, 0.82-0.89; < 0.00001). There was no significant difference in in-hospital morbidity in neurological, gastrointestinal, limb-related, bleeding, and infection complications between patients on VA-ECMO with and without IABP.
DISCUSSION
In these observational studies, concomitant use of IABP and VA-ECMO in adult patients with cardiogenic shock was associated with reduced in-hospital mortality.
SYSTEMATIC REVIEW REGISTRATION
PROSPERO [CRD42017069259].
引言
主动脉内球囊反搏（IABP）有时会与静脉 - 动脉体外膜肺氧合（VA - ECMO）联合使用，以治疗心源性休克患者。在本研究中，我们试图评估IABP应用方式与接受VA - ECMO治疗的心源性休克成年患者生存率和血管并发症发生率之间的关联。
方法
我们在PubMed、EMBASE和Cochrane图书馆系统检索了关于有或无IABP的VA - ECMO的原始研究。
结果
共纳入42项研究，涉及8759例患者。接受有IABP和无IABP的VA - ECMO治疗患者的院内死亡汇总数分别为2962/4807（61.61%）和2666/3952（67.45%）。使用IABP的VA - ECMO患者院内死亡率较低（风险比，0.88；95%置信区间，0.86 - 0.91；P＜0.00001）。此外，IABP与心脏术后心源性休克和缺血性心脏病患者较低的院内死亡率相关（风险比，0.93；95%置信区间，0.87 - 0.98；P = 0.01；风险比，0.85；95%置信区间，0.82 - 0.89；P＜0.00001）。在接受有IABP和无IABP的VA - ECMO治疗的患者之间，神经、胃肠道、肢体相关、出血和感染并发症的院内发病率无显著差异。
讨论
在这些观察性研究中，成年心源性休克患者同时使用IABP和VA - ECMO与降低院内死亡率相关。
系统评价注册
PROSPERO [CRD42017069259]
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