Effect of intra-aortic balloon pump with veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock: A meta-analysis
Restricted accessResearch articleFirst published online October, 2024
Effect of intra-aortic balloon pump with veno-arterial extracorporeal membrane oxygenation in acute myocardial infarction with cardiogenic shock: A meta-analysis
The effectiveness of a concomitant intra-aortic balloon pump (IABP) with veno-arterial extracorporeal membrane oxygenation (VA-ECMO) intervention in acute myocardial infarction with cardiogenic shock (AMICS) patients is contested in the literature. This study sought to compare short-term mortality weaning rate from VA-ECMOin AMICS cases.
Methods
We conducted a literature review and compared the primary and secondary endpoints in the following treatment groups of AMICS patients: (1) VA-ECMO plus IABP vs. IABP alone and (2) VA-ECMO plus IABP vs. VA-ECMO alone. The primary endpoint was in-hospital all-cause mortality; while 30-days mortality, weaning from VA-ECMO, and vascular complications comprised secondary endpoints.
Results
VA-ECMO concomitant with IABP was administered to 3,580 (76.4%) patients, while IABP alone and VA-ECMO alone treatments accounted for 1.7% and 21.9% of the patients, respectively. We found that in-hospital mortality was significantly lower in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (odds ratio (OR) = 0.52; 95% Confidence Interval (CI) = 0.21–1.31; I-squared statistic (I2 = 30%) or IABP alone (OR = 0.20; 95% CI = 0.08–0.55; I2 = 0%). Additionally, 30-days mortality was significantly lower in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (OR = 0.31; 95% CI = 0.25–0.40; I2 = 0%) or IABP alone (OR = 0.24; 95% CI = 0.11–0.50; I2 = 0%). A significant difference was observed in weaning from VA-ECMO in patients treated with VA-ECMO plus IABP vs. VA-ECMO alone (OR = 1.91; 95% CI = 1.09–3.33; I2 = 0%).
Conclusion
In-hospital and 30-days mortality were significantly lower in AMICS patients treated with VA-ECMO plus IABP vs. VA-ECMO alone or IABP alone. VA-ECMO with concomitant IABP could increase the proportion of patients weaned from VA-ECMO, significantly reducing in-hospital mortality, without increasing complications.
van DiepenSKatzJNAlbertNM, et al.Contemporary management of cardiogenic shock: a scientific statement from the american heart association. Circulation2017; 136(16): e232–e268.
2.
HarjolaVPLassusJSionisA, et al.Clinical picture and risk prediction of short-term mortality in cardiogenic shock. Eur J Heart Fail2015; 17(5): 501–509.
3.
LemorAYa’qoubLBasirMB. Mechanical circulatory support in acute myocardial infarction and cardiogenic shock. Interven Cardiol Clinics2021; 10(2): 169–184.
4.
KimmanJRVan MieghemNMEndemanH, et al.Mechanical support in early cardiogenic shock: what is the role of intra-aortic balloon counterpulsation?Curr Heart Fail Rep2020; 17(5): 247–260.
5.
MeaniPGelsominoSNatourE, et al.Modalities and effects of left ventricle unloading on extracorporeal life support: a review of the current literature. Eur J Heart Fail2017; 19(Suppl 2): 84–91.
6.
VallabhajosyulaSO'HoroJCAntharamP, et al.Concomitant intra-aortic balloon pump use in cardiogenic shock requiring veno-arterial extracorporeal membrane oxygenation. Circulation: Cardiovascular Interventions2018; 11(9): e006930.
7.
ThygesenKAlpertJSJaffeAS, et al.Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol2018; 72(18): 2231–2264.
8.
HigginsJPThompsonSGDeeksJJ, et al.Measuring inconsistency in meta-analyses. BMJ2003; 327(7414): 557–560.
9.
AoyamaNImaiHKurosawaT, et al.Therapeutic strategy using extracorporeal life support, including appropriate indication, management, limitation and timing of switch to ventricular assist device in patients with acute myocardial infarction. J Artif Organs2014; 17(1): 33–41.
10.
ChenJSKoWJYuHY, et al.Analysis of the outcome for patients experiencing myocardial infarction and cardiopulmonary resuscitation refractory to conventional therapies necessitating extracorporeal life support rescue*. Crit Care Med2006; 34(4): 950–957.
11.
ChungESLimCLeeHY, et al.Results of extracorporeal membrane oxygenation (ECMO) support before coronary reperfusion in cardiogenic shock with acute myocardial infarction. Korean J Thoracic Cardiovas Surg2011; 44(4): 273–278.
12.
KagawaEDoteKKatoM, et al.Should we emergently revascularize occluded coronaries for cardiac arrest?Circulation2012; 126(13): 1605–1613.
13.
KidaHSotomiYHikosoS, et al.Prognostic significance of intra-aortic balloon pumping support in patients with acute myocardial infarction and veno-arterial extracorporeal membrane oxygenation therapy. J Cardiol2022; 79(2): 179–185.
14.
LuoMZhouJQiuC, et al.Outcome of extracorporeal membrane oxygenation combined with intraaortic balloon pump hemodynamic support during the percutaneous coronary intervention process for patients with cardiac shock complicating acute myocardial infarction. J healthcare engin2022; 2022: 1350673.
15.
NegiSISokolovicMKoifmanE, et al.Contemporary use of veno-arterial extracorporeal membrane oxygenation for refractory cardiogenic shock in acute coronary syndrome. J Invasive Cardiol2016; 28(2): 52–57.
16.
NishiTIshiiMTsujitaK, et al.Outcomes of venoarterial extracorporeal membrane oxygenation plus intra-aortic balloon pumping for treatment of acute myocardial infarction complicated by cardiogenic shock. J Am Heart Assoc2022; 11(7): e023713.
17.
OvertchoukPPascalJLebretonG, et al.Outcome after revascularisation of acute myocardial infarction with cardiogenic shock on extracorporeal life support. EuroIntervention: Journal of EuroPCR in Collaboration with the Working Group on Interventional Cardiology of the European Society of Cardiology2018; 13(18): e2160–e2168.
18.
ParkTKYangJHChoiSH, et al.Clinical impact of intra-aortic balloon pump during extracorporeal life support in patients with acute myocardial infarction complicated by cardiogenic shock. BMC Anesthesiol2014; 14: 27.
19.
SheuJJTsaiTHLeeFY, et al.Early extracorporeal membrane oxygenator-assisted primary percutaneous coronary intervention improved 30-day clinical outcomes in patients with ST-segment elevation myocardial infarction complicated with profound cardiogenic shock. Crit Care Med2010; 38(9): 1810–1817.
20.
TsaoNWShihCMYehJS, et al.Extracorporeal membrane oxygenation-assisted primary percutaneous coronary intervention may improve survival of patients with acute myocardial infarction complicated by profound cardiogenic shock. J Crit Care2012; 27(5): 530–531.
21.
van den BrinkFSZivelonghiCVossenbergTN, et al.VA-ECMO With IABP is associated with better outcome than VA-ECMO alone in the treatment of cardiogenic shock in ST-elevation myocardial infarction. J Invasive Cardiol2021; 33(5): E387–E392.
22.
YamauchiTMasaiTTakedaK, et al.Percutaneous cardiopulmonary support after acute myocardial infarction at the left main trunk. Ann Thorac Cardiovasc Surg: Official Journal of the Association of Thoracic and Cardiovascular Surgeons of Asia2009; 15(2): 93–97.
23.
RomeoFAcconciaMCSergiD, et al.Percutaneous assist devices in acute myocardial infarction with cardiogenic shock: review, meta-analysis. World J Cardiol2016; 8(1): 98–111.
24.
SquiersJJLimaBDiMaioJM. Contemporary extracorporeal membrane oxygenation therapy in adults: fundamental principles and systematic review of the evidence. J Thorac Cardiovasc Surg2016; 152(1): 20–32.
25.
SamskyMDMorrowDAProudfootAG, et al.Cardiogenic shock after acute myocardial infarction. JAMA2021; 326(18): 1840–1850.
26.
BarboneAMalvindiPGFerraraP, et al.Left ventricle unloading by percutaneous pigtail during extracorporeal membrane oxygenation. Interact Cardiovasc Thorac Surg2011; 13(3): 293–295.
27.
BréchotNDemondionPSantiF, et al.Intra-aortic balloon pump protects against hydrostatic pulmonary oedema during peripheral venoarterial-extracorporeal membrane oxygenation. Eur Heart J: Acute Cardiovascular Care2018; 7(1): 62–69.
28.
WindeckerSWindeckerPKolhF, et al.2014 ESC/EACTS guidelines on myocardial revascularization: the task force on myocardial revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J, 2014,35(37):2541-2619.
29.
CaveDMGazmuriRJOttoCW, et al.Part 7: CPR techniques and devices: 2010 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation2010; 122(18 Suppl 3): S720–S728.
30.
BregmanDNicholsABWeissMB, et al.Percutaneous intraaortic balloon insertion. Am J Cardiol1980; 46(2): 261–264.
31.
SaurenLDReesinkKDSelderJL, et al.The acute effect of intra-aortic balloon counterpulsation during extracorporeal life support: an experimental study. Artif Organs2007; 31(1): 31–38.
32.
PhillipsSJZeffRHKongtahwornC, et al.Benefits of combined balloon pumping and percutaneous cardiopulmonary bypass. Ann Thorac Surg1992; 54(5): 908–910.
33.
TakayamaHTrubyLKoekortM, et al.Clinical outcome of mechanical circulatory support for refractory cardiogenic shock in the current era. J Heart Lung Transplant2013; 32(1): 106–111.
34.
RupprechtLFlörchingerBSchopkaS, et al.Cardiac decompression on extracorporeal life support. Am Soc Artif Intern Organs J2013; 59(6): 547–553.
35.
ChengRHachamovitchRMakkarR, et al.Lack of survival benefit found with use of intraaortic balloon pump in extracorporeal membrane oxygenation: a pooled experience of 1517 patients. J Invasive Cardiol2015; 27(10): 453–458.
36.
O'NeilMPFlemingJCBadhwarA, et al.Pulsatile Versus nonpulsatile flow during cardiopulmonary bypass: microcirculatory and systemic effects. Ann Thorac Surg2012; 94(6): 2046–2053.
37.
ChengRHachamovitchRKittlesonM, et al.Complications of extracorporeal membrane oxygenation for treatment of cardiogenic shock and cardiac arrest: a meta-analysis of 1,866 adult patients. Ann Thorac Surg2014; 97(2): 610–616.
38.
AliJMAbu-OmarY. Complications associated with mechanical circulatory support. Ann Transl Med2020; 8(13): 835–835.
39.
LiYYanSGaoS, et al.Effect of an intra-aortic balloon pump with venoarterial extracorporeal membrane oxygenation on mortality of patients with cardiogenic shock: a systematic review and meta-analysis†. Eur J Cardio Thorac Surg2019; 55(3): 395–404.
40.
ThieleHZeymerUNeumannFJ, et al.Intraaortic balloon support for myocardial infarction with cardiogenic shock. N Engl J Med2012; 367(14): 1287–1296.
