Venoarterial extracorporeal membrane oxygenation versus impella for cardiogenic shock in acute myocardial infarction: a systematic review and meta-analysis

ABSTRACT

BACKGROUND: Acute myocardial infarction (AMI) is an important cause of cardiogenic shock (CS). There is lack of evidence regarding the safety and efficacy of venoarterial extracorporeal membrane oxygenation (VA-ECMO) compared with Impella in this population. METHODS: We systematically searched PubMed, EMBASE, and Cochrane Library for studies comparing VA-ECMO with Impella in patients with CS related to AMI. The systematic review and meta-analysis followed Cochrane recommendations and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We used R version 4.3.1 for all statistical analyses. Odds ratios (OR) and 95% confidence intervals (CI) were pooled with a random-effects model. RESULTS: We included seven observational studies with 15.903 patients, of whom 12.943 (81.3%) were treated with Impella. There was no significant difference between groups regarding in-hospital mortality (OR 0.79; 95% CI 0.37-1.69; p=0.54; Figure 1A), ischemic stroke (OR 0.69; 95% CI 0.14-3.35; p=0.64; Figure 1B), acute kidney injury (OR 1.22; 95% CI 0.55-2.70; p=0.62), renal replacement therapy or dialysis (OR 1.02; 95% CI 0.33-3.19; p=0.97; Figure 1C), and blood transfusion (OR 0.52; 95% CI 0.16-1.72; p=0.28). CONCLUSION: In this meta-analysis, there was no significant difference between VA-ECMO and Impella among patients with CS and AMI for the outcomes of in-hospital mortality, ischemic stroke, acute kidney injury, renal replacement therapy, or blood transfusion.