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Multiparameters associated to successful weaning from VA ECMO in adult patients with cardiogenic shock or cardiac arrest: Systematic review and meta-analysis


1 Heart Failure, Pulmonary Hypertension and Transplant Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
2 Critical care Cardiology Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos, Aires, Argentina
3 Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos, Aires, Argentina
4 Penn State Heart and Vascular Institute (HVI), Critical Care Unit, Penn State Health Milton S. Hershey Medical Center (HMC) and Penn State University. Hershey, USA and INSERM 970, Paris, France

Correspondence Address:
Lucrecia María Burgos
Instituto Cardiovascular de Buenos Aires, Blanco Encalada 1543, CABA. CP1428
Argentina
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_79_22

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Year : 2023  |  Volume : 26  |  Issue : 1  |  Page : 4-11

 

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Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39–50%, I2 7%) and in-hospital mortality rate was 46.6% (95%CI: 33–60%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3–18) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8–26.4 I2 = 0) were higher. They also had lower values of creatinine [MD –0.59 (95%CI: –0.9 to –0.2) I2 = 7%], lactate [MD –3.1 (95%CI: –5.4 to –0.7) I2 = 89%], and creatine kinase [–2779.5 (95%CI: –5387 to –171) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: –0.2–36.2) I2 = 91%, and MD 15.9% (95%CI 11.9–20) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.






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1 Heart Failure, Pulmonary Hypertension and Transplant Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos Aires, Argentina
2 Critical care Cardiology Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos, Aires, Argentina
3 Cardiac Surgery Department, Instituto Cardiovascular de Buenos Aires (ICBA), Buenos, Aires, Argentina
4 Penn State Heart and Vascular Institute (HVI), Critical Care Unit, Penn State Health Milton S. Hershey Medical Center (HMC) and Penn State University. Hershey, USA and INSERM 970, Paris, France

Correspondence Address:
Lucrecia María Burgos
Instituto Cardiovascular de Buenos Aires, Blanco Encalada 1543, CABA. CP1428
Argentina
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/aca.aca_79_22

Rights and Permissions

Venoarterial extracorporeal membrane oxygenation (VA ECMO) is a form of temporary mechanical circulatory support and simultaneous extracorporeal gas exchange for acute cardiorespiratory failure, including refractory cardiogenic shock (CS) and cardiac arrest (CA). Few studies have assessed predictors of successful weaning (SW) from VA ECMO. This systematic review and meta-analysis aimed to identify a multiparameter strategy associated with SW from VA ECMO. PubMed and the Cochrane Library and the International Clinical Trials Registry Platform were searched. Studies reporting adult patients with CS or CA treated with VA ECMO published from the year 2000 onwards were included. Primary outcomes were hemodynamic, laboratory, and echocardiography parameters associated with a VA ECMO SW. A total of 11 studies (n=653) were included in this review. Pooled VA ECMO SW was 45% (95%CI: 39–50%, I2 7%) and in-hospital mortality rate was 46.6% (95%CI: 33–60%; I2 36%). In the SW group, pulse pressure [MD 12.7 (95%CI: 7.3–18) I2 = 0%] and mean blood pressure [MD 20.15 (95%CI: 13.8–26.4 I2 = 0) were higher. They also had lower values of creatinine [MD –0.59 (95%CI: –0.9 to –0.2) I2 = 7%], lactate [MD –3.1 (95%CI: –5.4 to –0.7) I2 = 89%], and creatine kinase [–2779.5 (95%CI: –5387 to –171) I2 = 38%]. And higher left and right ventricular ejection fraction, MD 17.9% (95%CI: –0.2–36.2) I2 = 91%, and MD 15.9% (95%CI 11.9–20) I2 = 0%, respectively. Different hemodynamic, laboratory, and echocardiographic parameters were associated with successful device removal. This systematic review demonstrated the relationship of multiparametric assessment on VA ECMO SW.






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